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Schmidt C, Magalhães S, Gois Basilio P, Gouveia M, Teixeira M, Santos C, Tavares AI, Ferreira JP, Ribeiro F, Santos M. Home- versus centre-based EXercise InTervention in patients with Heart Failure (EXIT-HF trial): A pragmatic randomized controlled trial. Rev Port Cardiol 2024; 43:149-158. [PMID: 37716466 DOI: 10.1016/j.repc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION The limited accessibility and the lack of adherence explain, in part, the low proportion of heart failure (HF) patients undergoing exercise-based cardiac rehabilitation (CR) programs. Home-based programs showed to be as effective and less costly than centre-based ones and might address those obstacles. Whether the evidence from international studies can be applied to our population is still unclear. OBJECTIVES To compare the clinical and economic impact of a home-based versus centre-based CR intervention in HF patients. METHODS This is a single-center, single-blind, parallel groups, non-inferiority pragmatic randomized control trial. Adult HF patients (n=120) will be randomized to either a centre-based or home-based CR program. In both groups' patients will participate in a 12-week combined CR program with 2 sessions per week. Exercise training (ExT) protocol consists of a combination of endurance [(at 60%-80% of peak oxygen uptake (VO2peak)] and resistance training (elastic bands). Those allocated to the home-based program will start with 4-5 supervised ExT sessions to familiarize themselves with the training protocol and then will continue the remaining sessions at home. The primary endpoint is the change in VO2peak at the end of the 12-week program. Secondary outcomes include alterations in circulating biomarkers, physical fitness, physical activity, quality of life, diet, psychological wellbeing, dyspnea, and cost-effectiveness analyses. RESULTS Patients are currently being recruited for the study. The study started in November 2019 and data collection is anticipated to be completed by December 2022. This is the first study in Portugal comparing the traditional CR program with a home-based program in HF patients. Our study results will better inform healthcare professionals who care for HF patients regarding CR.
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Affiliation(s)
- Cristine Schmidt
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Portugal; Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Sandra Magalhães
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal
| | - Priscilla Gois Basilio
- Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Marisol Gouveia
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Portugal
| | - Manuel Teixeira
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Portugal
| | - Cláudio Santos
- Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Aida Isabel Tavares
- CEISUC - Centre for Health Studies and Research, University of Coimbra, Coimbra, Portugal; ISEG, UL - Lisbon School of Economics and Management, University of Lisbon, Portugal
| | - João Pedro Ferreira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques, Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Fernando Ribeiro
- iBiMED - Institute of Biomedicine, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Mário Santos
- Cardiology Service, Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal; UMIB, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
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Waterworth CJ, Smith F, Kiefel-Johnson F, Pryor W, Marella M. Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low- and middle-income countries: a scoping review. Disabil Rehabil 2024:1-12. [PMID: 38376099 DOI: 10.1080/09638288.2024.2317422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Integration is a concept that seeks to strengthen the delivery of services to ensure people receive a continuum of care across the health system. We conducted a scoping review to explore how rehabilitation services have been integrated into health systems in low- and middle- income countries (LMICs). MATERIALS AND METHODS We conducted a scoping review using Valentijn's Rainbow Model of Integrated Care (RMIC) as an organising framework. The key enablers of integration of rehabilitation were extracted, charted and summarised according to the RMIC framework. RESULTS Of 4667 articles identified, 44 met inclusion criteria. Most studies focused on rehabilitation within secondary and tertiary level facilities, and described service models incorporating clinical, professional and functional integration characteristics. The geographical and clinical scope of rehabilitation models that demonstrate elements of integration from LMICs is limited. CONCLUSION The key enablers identified highlight the important role of responsive multidisciplinary care plans, and interdisciplinary guidelines, protocols and interprofessional education to support an integrated rehabilitation service model in LMICs.
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Affiliation(s)
- Christopher James Waterworth
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - Fleur Smith
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Felix Kiefel-Johnson
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Wesley Pryor
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Manjula Marella
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
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Ghisi GLDM, Kim WS, Cha S, Aljehani R, Cruz MMA, Vanderlei LCM, Pepera G, Liu X, Xu Z, Maskhulia L, Venturini E, Chuang HJ, Pereira DG, Trevizan PF, Kouidi E, Batalik L, Ghanbari Firoozabadi M, Burazor I, Jiandani MP, Zhang L, Tourkmani N, Grace SL. Women's Cardiac Rehabilitation Barriers: Results of the International Council of Cardiovascular Prevention and Rehabilitation's First Global Assessment. Can J Cardiol 2023; 39:S375-S383. [PMID: 37747380 DOI: 10.1016/j.cjca.2023.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status. METHODS In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated. RESULTS Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5). CONCLUSIONS CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Won-Seok Kim
- Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seungwoo Cha
- Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Raghdah Aljehani
- Rehabilitation Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Mayara Moura Alves Cruz
- São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil
| | | | - Garyfallia Pepera
- Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Xia Liu
- Chengdu Wanda UPMC Hospital, Chengdu, China
| | - Zhimin Xu
- Shanghai Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lela Maskhulia
- TSMU Sports Medicine and Rehabilitation Clinical Centre, Cardiac Rehabilitation, Tbilisi, Georgia
| | - Elio Venturini
- Department of Cardiac Rehabilitation, Cecina Hospital, Cecina, Italy
| | - Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Danielle Gomes Pereira
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Patricia Fernandes Trevizan
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Repub
| | - Mahdieh Ghanbari Firoozabadi
- Yazd Cardiovascular Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ivana Burazor
- Institute for Cardiovascular Diseases "Dedinje" and Belgrade University, Faculty of Medicine, Belgrade, Serbia
| | | | - Ling Zhang
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Nidal Tourkmani
- Rehabilitation Clinic "Mons. G. Calaciura," Biancavilla, Catania, Italy; "Gibiino" Cardiovascular Diagnostic Center, Catania, Italy
| | - Sherry L Grace
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada.
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Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
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Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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Komiyama J, Sugiyama T, Iwagami M, Ishimaru M, Sun Y, Matsui H, Kume K, Sanuki M, Koyama T, Kato G, Mori Y, Ueshima H, Tamiya N. Hospital-Level Variation in Cardiac Rehabilitation After Myocardial Infarction in Japan During Fiscal Years 2014-2015 Using the National Database. Circ Rep 2023; 5:177-186. [PMID: 37180473 PMCID: PMC10166669 DOI: 10.1253/circrep.cr-22-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 05/16/2023] Open
Abstract
Background: Cardiac rehabilitation (CR) is an evidence-based medical service for patients with acute myocardial infarction (AMI); however, its implementation is inadequate. We investigated the provision status and equality of CR by hospitals in Japan using a comprehensive nationwide claims database. Methods and Results: We analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups in Japan for the period April 2014-March 2016. We identified patients aged ≥20 years with postintervention AMI. We calculated hospital-level proportions of inpatient and outpatient CR participation. The equality of hospital-level proportions of inpatient and outpatient CR participation was evaluated using the Gini coefficient. We included 35,298 patients from 813 hospitals for the analysis of inpatients and 33,328 patients from 799 hospitals for the analysis of outpatients. The median hospital-level proportions of inpatient and outpatient CR participation were 73.3% and 1.8%, respectively. The distribution of inpatient CR participation was bimodal; the Gini coefficients of inpatient and outpatient CR participation were 0.37 and 0.73, respectively. Although there were statistically significant differences in the hospital-level proportion of CR participation for several hospital factors, CR certification status for reimbursement was the only visually evident factor affecting the distribution of CR participation. Conclusions: The distributions of inpatient and outpatient CR participation by hospitals were suboptimal. Further research is warranted to determine future strategies.
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Affiliation(s)
- Jun Komiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba Tsukuba Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba Tsukuba Japan
| | - Takehiro Sugiyama
- Department of Health Services Research, Institute of Medicine, University of Tsukuba Tsukuba Japan
- Health Services Research and Development Center, University of Tsukuba Tsukuba Japan
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine Tokyo Japan
- Institute for Global Health Policy, Bureau of International Health Cooperation, National Center for Global Health and Medicine Tokyo Japan
| | - Masao Iwagami
- Department of Health Services Research, Institute of Medicine, University of Tsukuba Tsukuba Japan
- Health Services Research and Development Center, University of Tsukuba Tsukuba Japan
| | - Miho Ishimaru
- Health Services Research and Development Center, University of Tsukuba Tsukuba Japan
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Tokyo Japan
| | - Yu Sun
- Graduate School of Comprehensive Human Sciences, University of Tsukuba Tsukuba Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba Tsukuba Japan
- Health Services Research and Development Center, University of Tsukuba Tsukuba Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo Tokyo Japan
| | - Keitaro Kume
- Department of Clinical Medicine, University of Tsukuba Tsukuba Japan
| | - Masaru Sanuki
- Department of Clinical Medicine, University of Tsukuba Tsukuba Japan
| | - Teruyuki Koyama
- Department of Rehabilitation, Kameda Medical Center Kamogawa Japan
| | - Genta Kato
- Solutions Center for Health Insurance Claims, Kyoto University Hospital Kyoto Japan
| | - Yukiko Mori
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital Kyoto Japan
| | - Hiroaki Ueshima
- Health Services Research and Development Center, University of Tsukuba Tsukuba Japan
- Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University Kyoto Japan
| | - Nanako Tamiya
- Department of Health Services Research, Institute of Medicine, University of Tsukuba Tsukuba Japan
- Health Services Research and Development Center, University of Tsukuba Tsukuba Japan
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Calvo-López M, Arranz Tolós R, Marin Expósito J, Gruosso D, Andrea R, Roque M, Falces C, Yago G, Saura Araguas J, Pastor N, Sitges M, Sanz-de la Garza M. Cardio4Health Study, a Cardiac Telerehabilitation Pilot Program Aimed at Patients After an Ischemic Event: Cross-sectional Study. JMIR Cardio 2023; 7:e44179. [PMID: 37093637 PMCID: PMC10167584 DOI: 10.2196/44179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/14/2023] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underused. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and female patients. OBJECTIVE This study aimed to develop a holistic home-based CRP for patients with ischemic heart disease and evaluate its safety and impact on functional capacity, adherence to a healthy lifestyle, and quality of life. METHODS The 8-week home-based CRP included patients of both sexes, with no age limit, who had overcome an acute myocardial infarction in the previous 3 months, had a left ventricular ejection fraction of ≥40%, and had access to a tablet or mobile device. The CRP was developed using a dedicated platform designed explicitly for this purpose and included 3 weekly exercise sessions combining tailored aerobic and strength training and 2 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment. RESULTS We initially included 62 patients, of whom 1 was excluded for presenting with ventricular arrhythmias during the initial stress test, 5 were excluded because of incompatibility, and 6 dropped out because of a technological barrier. Ultimately, 50 patients completed the program: 85% (42/50) were male, with a mean age of 58.9 (SD 10.3) years, a mean left ventricular ejection fraction of 52.1% (SD 6.72%), and 25 (50%) New York Heart Association functional class I and 25 (50%) New York Heart Association II-III. The CRP significantly improved functional capacity (+1.6 metabolic equivalent tasks), muscle strength (arm curl test +15.5% and sit-to-stand test +19.7%), weekly training volume (+803 metabolic equivalent tasks), adherence to the Mediterranean diet, emotional state (anxiety), and quality of life. No major complications occurred, and adherence was excellent (>80%) in both the exercise and educational sessions. In the subgroup analysis, CRP showed equivalent beneficial effects irrespective of sex and age. In addition, patient preferences for CRP approaches were equally distributed, with one-third (14/50, 29%) of the patients preferring a face-to-face CRP, one-third (17/50, 34%) preferring a telematic CRP, and one-third (18/50, 37%) preferring a hybrid approach. Regarding CRP duration, 63% (31/50) of the patients considered it adequate, whereas the remaining 37% (19/50) preferred a longer program. CONCLUSIONS A holistic telematic CRP dedicated to patients after an ischemic cardiac event, irrespective of sex and age, is safe and, in our population, has achieved positive results in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with diet, and anxiety symptoms. The preference for a center- or home-based CRP approach is diverse among the study population, emphasizing the need for a tailored CRP to improve adherence and completion rates.
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Affiliation(s)
| | | | | | - Domenico Gruosso
- Cardiovascular Clinical Institute, Hospital Clínic, Barcelona, Spain
| | - Rut Andrea
- Cardiovascular Clinical Institute, Hospital Clínic, Barcelona, Spain
| | - Mercè Roque
- Cardiovascular Clinical Institute, Hospital Clínic, Barcelona, Spain
| | - Carles Falces
- Cardiovascular Clinical Institute, Hospital Clínic, Barcelona, Spain
| | - Gemma Yago
- Cardiovascular Institute, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Nuria Pastor
- HumanITcare, Small Medium Enterprise (SME), Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Clinical Institute, Hospital Clínic, Barcelona, Spain
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Aljehani R, Grace SL, Aburub A, Turk-Adawi K, Ghisi GLDM. Translation, Cross-Cultural Adaptation and Psychometric Validation of the Arabic Version of the Cardiac Rehabilitation Barriers Scale (CRBS-A) with Strategies to Mitigate Barriers. Healthcare (Basel) 2023; 11:healthcare11081196. [PMID: 37108029 PMCID: PMC10138187 DOI: 10.3390/healthcare11081196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiac rehabilitation (CR) utilization is low, particularly in Arabic-speaking countries. This study aimed to translate and psychometrically validate the CR Barriers Scale in Arabic (CRBS-A), as well as strategies to mitigate them. The CRBS was translated by two bilingual health professionals independently, followed by back-translation. Next, 19 healthcare providers, followed by 19 patients rated the face and content validity (CV) of the pre-final versions, providing input to improve cross-cultural applicability. Then, 207 patients from Saudi Arabia and Jordan completed the CRBS-A, and factor structure, internal consistency, construct, and criterion validity were assessed. Helpfulness of mitigation strategies was also assessed. For experts, item and scale CV indices were 0.8-1.0 and 0.9, respectively. For patients, item clarity and mitigation helpfulness scores were 4.5 ± 0.1 and 4.3 ± 0.1/5, respectively. Minor edits were made. For the test of structural validity, four factors were extracted: time conflicts/lack of perceived need and excuses; preference to self-manage; logistical problems; and health system issues and comorbidities. Total CRBS-A α was 0.90. Construct validity was supported by a trend for an association of total CRBS with financial insecurity regarding healthcare. Total CRBS-A scores were significantly lower in patients who were referred to CR (2.8 ± 0.6) vs. those who were not (3.6 ± 0.8), confirming criterion validity (p = 0.04). Mitigation strategies were considered very helpful (mean = 4.2 ± 0.8/5). The CRBS-A is reliable and valid. It can support identification of top barriers to CR participation at multiple levels, and then strategies for mitigating them can be implemented.
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Affiliation(s)
- Raghdah Aljehani
- Rehabilitation Department, King Abdullah Medical City, Makkah 24246, Saudi Arabia
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Aseel Aburub
- Department of Physiotherapy, Applied Science Private University, Amman 11931, Jordan
| | - Karam Turk-Adawi
- College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
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8
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Borah N, Bhawalkar JS, Rathod H, Jadav V, Gangurde S, S J. Challenges to Cardiac Rehabilitation Post Coronary Artery Bypass Grafting: A Qualitative Study in Pune. Cureus 2023; 15:e35755. [PMID: 37033594 PMCID: PMC10075025 DOI: 10.7759/cureus.35755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Background Adherence to cardiac rehabilitation (CR) regimen is crucial in the post-coronary artery bypass grafting (CABG) period. Cardiac rehabilitation involves various lifestyle changes, including diet and exercise, regular follow-up in OPD, and implementing secondary prevention recommendations. This study aims to understand the challenges to CR post-CABG. Methodology Seven in-depth interviews using an interview guide were carried out in the outpatient section of the cardiothoracic vascular surgery (CTVS) department of a tertiary health care facility in Pune, India. A purposive sampling technique was followed. Results The qualitative study revealed that dietary restrictions were difficult to follow, that some patients could not quit smoking even after surgery, and that transportation costs were an issue regarding CR follow-up. The majority of the participants appreciated the importance of regular exercise in their post-surgery life. Conclusion Despite the hurdles, the majority of participants stated that the fact that CABG is a major treatment pushed them to attend routine CR follow-ups and adhere to the CR regimen. A solid CR team was one of the study's strengths, and the team established a routine of telephonic reminders for regular follow-up, which resulted in lower rates of loss to follow-up.
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Effect of a Home-Based Mobile Health App Intervention on Physical Activity Levels in Patients With Heart Failure: A Randomized Controlled Trial. J Cardiovasc Nurs 2023; 38:128-139. [PMID: 35389920 DOI: 10.1097/jcn.0000000000000911] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The use of mobile health applications (apps) is an effective strategy in supporting patients' self-management of heart failure (HF) in home settings, but it remains unclear whether they can be used to reduce sedentary behaviors and increase overall physical activity levels. AIM The aims of this study were to determine the effect of an 8-week home-based mobile health app intervention on physical activity levels and to assess its effects on symptom burden and health-related quality of life. METHOD In this study, we collected repeated-measures data from 132 participants with HF (60.8 ± 10.47 years) randomized into a usual care group (n = 67) or an 8-week home-based mobile health app intervention group (n = 65). The intervention was tailored to decrease the time spent in sedentary behavior and to increase the time spent in physical activities performed at light or greater intensity levels. Physical activity levels were monitored for 2 weeks before the intervention and during the 8-week intervention using the Samsung mobile health app. Heart failure symptom burden and health-related quality of life were assessed at baseline, 2 weeks from baseline assessment, and immediately post intervention. RESULTS At week 8, all participants in the intervention group demonstrated an increase in the average daily step counts above the preintervention counts (range of increase: 2351-7925 steps/d). Only 29 participants (45%) achieved an average daily step count of 10 000 or higher by week 6 and maintained their achievement to week 8 of the intervention. Repeated-measures analysis of variance showed a significant group-by-time interaction, indicating that the intervention group had a greater improvement in physical activity levels, symptom burden, and health-related quality of life than the usual care group. CONCLUSION Home-based mobile health app-based interventions can increase physical activity levels and can play an important role in promoting better HF outcomes.
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Guo M, Gu M, Gu Y, Zhu J, Huo B, Wang D. The impacts of the combination service model of cardiac rehabilitation on patient outcomes: evidence from a hospital experience. Biotechnol Genet Eng Rev 2023:1-20. [PMID: 36823969 DOI: 10.1080/02648725.2023.2180718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
This research is to test whether the combination model (CM) (combining cardiac rehabilitation (CR) with other cardiovascular medical services) impact patients' readmissions, physical and psychological outcomes. We found that CM significantly enhances patients' exercise ability and psychological condition and reduces readmission rates after discharged from the hospital, compared to patients that are admitted to non-CM. Departments' physical resources weaken the impact of CM on patients' physical outcomes and readmission rates while increasing patients' psychological conditions. Human resources strengthen the impact of CM on patients' readmission rates while reducing the impact on patients' physical outcomes. Our results provide empirical evidence for hospital resource constraints puzzle and reallocation. These results provide a possibility of introducing CM as a way to deal with CR implementing challenges.
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Affiliation(s)
- Mengqiu Guo
- College of Management and Economics, Tianjin University, Tianjin, China
- School of Management, Zhengzhou University, Zhengzhou, Henan, China
| | - Minhao Gu
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Yingchun Gu
- Department of Cardiac Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Jinyun Zhu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Baofeng Huo
- School of Management, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dongwei Wang
- Department of Cardiac Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
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11
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Khushhal A, Alsubaiei M. Barriers to Establishing Outpatient Cardiac Rehabilitation in the Western Region of Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc 2023; 16:653-661. [PMID: 36923361 PMCID: PMC10010741 DOI: 10.2147/jmdh.s398687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Background The core of cardiac rehabilitation (CR) is structured exercise training. CR reduces 28-56% hospital readmission rate, and around 25% increases cardiorespiratory fitness but the number of outpatients CR centers in Saudi Arabia (SA) is very limited and there is a need to establish outpatient CR (Phase III) in SA. Furthermore, the awareness of outpatient CR in SA is unknown. Aim To determine the main barriers to establishing an outpatient CR program (Phase III) in the western region of SA, as well as assess the awareness of outpatient CR (Phase III) in the western region of SA. Methods A cross-sectional study survey was conducted between March - July 2021 among physiotherapists, cardiologists and the cardiac surgeon using a questionnaire distributed electronically to determine the awareness level of outpatient CR and barriers to establishing outpatient CR (Phase III) in the western region of SA. Frequencies and percentages were used to report the variables. Results Of the 141 participants who completed the online survey, our findings showed that 131 (93%) were aware of CR but only 29 (21%) were aware of the four phases of CR. There were three main barriers to establishing CR: lack of appropriate CR 135 (96%); lack of awareness among healthcare professions of CR and its benefits 134 (95%) and the lack of healthcare providers trained in CR 133 (94%). There was a significant relationship between physiotherapists and cardiologists' responses on agreeing to all barriers to establishing CR in SA (r=0.69, P =0.03). Conclusion To overcome the barriers to establishing CR outpatient centers in the western region of SA, it is recommended to provide more CR outpatient training programs to healthcare providers and raise the awareness of the CR phases, its benefits, and the risk factors for developing cardiac diseases among healthcare providers.
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Affiliation(s)
- Alaa Khushhal
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohammed Alsubaiei
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Imam Abulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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12
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Xie X, Chen Q, Liu H. Barriers to hospital-based phase 2 cardiac rehabilitation among patients with coronary heart disease in China: a mixed-methods study. BMC Nurs 2022; 21:333. [PMID: 36447215 PMCID: PMC9706833 DOI: 10.1186/s12912-022-01115-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) has become a leading cause of morbidity and premature death worldwide. Cardiac rehabilitation (CR) was proved to have substantial benefits for patients with CHD. The CR was divided into three phases. Phase 2 is the important part of CR which involves hospital-based structured and closely monitored exercises and activities. However, CR utilization is low worldwide. The barriers to hospital-based phase 2 CR in China have not been well identified. AIMS To investigate barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in China and to explore the reasons. METHODS This study employed an explanatory sequential mixed-methods design. The study was conducted in a university hospital in China from July 2021 to December 2021. Quantitative data was collected through the Cardiac Rehabilitation Barrier Scale. Qualitative data was collected through unstructured face-to-face interviews. Data analysis included descriptive statistics and inductive qualitative content analysis. RESULTS One hundred and sixty patients completed the Cardiac Rehabilitation Barrier Scale and 17 patients participated in unstructured face-to-face interviews. The main barriers identified were distance (3.29 ± 1.565), transportation (2.99 ± 1.503), cost (2.76 ± 1.425), doing exercise at home (2.69 ± 1.509) and time constraints (2.48 ± 1.496). Six themes were identified; logistical factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression of CR team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information that emerged in the qualitative phase. CONCLUSION This study provides a better understanding of the barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in the Chinese context during the Covid-19 pandemic. Innovative programs such as home-based CR, mobile health, and hybrid programs might be considered to overcome some of these barriers. In addition, psychosocial intervention should be included in these programs to mitigate some of the barriers associated with the impression of CR team and psychological distress.
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Affiliation(s)
- Xiaoqi Xie
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Qiongshan Chen
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Hui Liu
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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13
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Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal. J Cardiovasc Dev Dis 2022; 9:jcdd9100344. [PMID: 36286296 PMCID: PMC9604186 DOI: 10.3390/jcdd9100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p < 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p < 0.01). Patients enrolled in CR were more likely to be treated with sacubitril/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p < 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1.04; 95% CI 1.01−1.07), higher education level (adjusted OR 3.31; 95% CI 1.63−6.70), stroke (adjusted OR 3.29; 95% CI 1.06−10.27), COPD (adjusted OR 4.82; 95% CI 1.53−15.16), and no ICD status (adjusted OR 2.68; 95% CI 1.36−5.26) were independently associated with CR non-enrollment. The main reasons for not being enrolled in CR were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Despite the relatively high proportion (35%) of HFrEF patients who underwent CR, the enrollment rate can be further improved. Innovative multi-level strategies addressing physicians’ awareness, patients’ comorbidities, and geographical issues should be pursued.
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14
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Ebinger JE, Lan R, Driver MP, Rushworth P, Luong E, Sun N, Nguyen T, Sternbach S, Hoang A, Diaz J, Heath M, Claggett BL, Bairey Merz CN, Cheng S. Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County. J Am Heart Assoc 2022; 11:e026472. [PMID: 36073630 PMCID: PMC9683686 DOI: 10.1161/jaha.121.026472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Background Exercise-based cardiac rehabilitation (CR) is known to reduce morbidity and mortality for patients with cardiac conditions. Sociodemographic disparities in accessing CR persist and could be related to the distance between where patients live and where CR facilities are located. Our objective is to determine the association between sociodemographic characteristics and geographic proximity to CR facilities. Methods and Results We identified actively operating CR facilities across Los Angeles County and used multivariable Poisson regression to examine the association between sociodemographic characteristics of residential proximity to the nearest CR facility. We also calculated the proportion of residents per area lacking geographic proximity to CR facilities across sociodemographic characteristics, from which we calculated prevalence ratios. We found that racial and ethnic minorities, compared with non-Hispanic White individuals, more frequently live ≥5 miles from a CR facility. The greatest geographic disparity was seen for non-Hispanic Black individuals, with a 2.73 (95% CI, 2.66-2.79) prevalence ratio of living at least 5 miles from a CR facility. Notably, the municipal region with the largest proportion of census tracts comprising mostly non-White residents (those identifying as Hispanic or a race other than White), with median annual household income <$60 000, contained no CR facilities despite ranking among the county's highest in population density. Conclusions Racial, ethnic, and socioeconomic characteristics are significantly associated with lack of geographic proximity to a CR facility. Interventions targeting geographic as well as nongeographic factors may be needed to reduce disparities in access to exercise-based CR programs. Such interventions could increase the potential of CR to benefit patients at high risk for developing adverse cardiovascular outcomes.
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Affiliation(s)
- Joseph E. Ebinger
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Roy Lan
- College of MedicineUniversity of Tennessee Health Science CenterMemphisTN
| | - Matthew P. Driver
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | | | - Eric Luong
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Nancy Sun
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Trevor‐Trung Nguyen
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Sarah Sternbach
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Amy Hoang
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Jacqueline Diaz
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Mallory Heath
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | | | - C. Noel Bairey Merz
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Susan Cheng
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
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15
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Kai SHY, Ferrières J, Rossignol M, Bouisset F, Herry J, Esquirol Y. Prevalence and determinants of return to work after various coronary events: meta-analysis of prospective studies. Sci Rep 2022; 12:15348. [PMID: 36097026 PMCID: PMC9468005 DOI: 10.1038/s41598-022-19467-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/30/2022] [Indexed: 11/29/2022] Open
Abstract
Return to work (RTW) after a coronary event remains a major concern. This systematic review and meta-analysis of prospective studies published between January 1988 and August 2020, aim to evaluate the prevalence of RTW after a coronary event (myocardial infarction, acute coronary syndrome, angina pectoris) and to assess the determinants of RTW (such as follow-up duration, date of recruitment, country, gender, occupational factors, etc.). PRISMA and MOOSE guidelines were followed. Study quality was assessed using the Newcastle–Ottawa Scale. Random-effects models were carried out to determine pooled prevalence estimates and 95% confident interval. A total of 43 prospective studies (34,964 patients) were investigated. RTW overall random effects pooled prevalence was estimated at 81.1% [95% CI 75.8–85.8]. Country, year of implementation or gender did not significantly modify the prevalence estimates. Lower level of education and degraded left ventricular ejection fraction decreased RTW prevalence estimates (respectively, 76.1% vs 85.6% and 65.3% vs 77.8%). RTW prevalence estimates were higher for white-collars (81.2% vs 65.0% for blue-collars) and people with low physical workload (78.3% vs 64.1% for elevated physical workload).Occupational physical constraints seem to have a negative role in RTW while psycho-logical factors at work are insufficiently investigated. A better understanding of the real-life working conditions influencing RTW would be useful to maintain coronary patients in the labor market.
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Affiliation(s)
- Samantha Huo Yung Kai
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Epidemiology, Toulouse University Hospital, 31000, Toulouse, France
| | - Jean Ferrières
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Cardiology, Toulouse University Hospital, 31400, Toulouse, France
| | - Mélisande Rossignol
- Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France
| | - Frédéric Bouisset
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Cardiology, Toulouse University Hospital, 31400, Toulouse, France
| | - Julie Herry
- Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France
| | - Yolande Esquirol
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France. .,Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France.
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16
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DE Lima AP, Pereira DG, Nascimento IO, Martins TH, Oliveira AC, Nogueira TS, Britto RR. Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial. Eur J Phys Rehabil Med 2022; 58:598-605. [PMID: 35634888 PMCID: PMC9980526 DOI: 10.23736/s1973-9087.22.07340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The benefits of cardiac rehabilitation (CR) are already well established; however, such intervention has been underused, mainly in low- and middle-income countries. AIM To compare adherence, effectiveness, and cost of a home CR with the traditional CR (TCR) in a middle-income country (MIC). DESIGN Single-blind randomized control trial. SETTING A university hospital. POPULATION Individuals with coronary disease that were eligible were invited to participate. A randomized sample of 51 individuals was selected, where two participants were not included by not meeting inclusion criteria. METHODS The home-CR group participated in health education activities, carried out two supervised exercise sessions, and was instructed to carry out 58 sessions at home. Weekly telephone calls were made. The TCR group held 24 supervised exercise sessions and were instructed to carry out 36 sessions at home. RESULTS 49 individuals (42 male, 56.37±10.35years) participated in the study, 23 in the home-CR group and 26 in the TCR group. After the intervention, adherence in the home-CR and TCR groups was 94.18% and 79.08%, respectively, with no significant difference (P=0.191). Both protocols were effective for the other variables, with no differences. The cost per patient for the service was lower in the home-CR (US$ 59.31) than in the TCR group (US$ 135.05). CONCLUSIONS CR performed at home in an MIC demonstrated similar adherence and effectiveness compared to the TCR program, but with a lower cost for the service. The results corroborate the possibility of using home CR programs, even in MICs, after exercise risk stratification and under remote supervision. CLINICAL REHABILITATION IMPACT Home-CR can contribute to overcome participants' barriers with compatible cost. Home-CR is effective in improving functional capacity and risk factors control. Perform risk stratification and remote supervision are essential to offer Home-CR.
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Affiliation(s)
- Ana P DE Lima
- University Center of Belo Horizonte (Uni-BH), Belo Horizonte, Brazil
| | - Danielle G Pereira
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil -
| | - Isabella O Nascimento
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Thiago H Martins
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Anne C Oliveira
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Tiago S Nogueira
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Raquel R Britto
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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17
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Miralles-Resurreccion KV, Grace SL, Cuenza LR. Trends in cardiac rehabilitation enrollment post-coronary artery bypass grafting upon implementation of automatic referral in Southeast Asia: A retrospective cohort study. J Cardiovasc Thorac Res 2022; 14:84-89. [PMID: 35935385 PMCID: PMC9339729 DOI: 10.34172/jcvtr.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cardiac rehabilitation (CR) is an effective but underutilized intervention. Strategies have been identified to increase its use, but there is paucity of data testing them in low-resource settings. We sought to determine the effect of automatic referral post-coronary artery bypass graft (CABG) surgery on CR enrollment.
Methods: This is a retrospective cohort study assessing cardiac patients referred to CR at a tertiary center in Southeast Asia from 2013 to 2019. The paper-based pathway was introduced at the end of 2012. The checklist with automatic CR referral on the third day post-operation prompted a nurse to educate the patient about CR, initiate phase 1 and encourage enrollment in phase 2. Patients who were not eligible for the pathway for administrative or clinical reasons were referred at the discretion of the attending physician (i.e., usual care). Enrollment was defined as attendance at≥1 CR visit. Results: Of 4792 patients referred during the study period, 394 enrolled in CR. Significantly more patients referred automatically enrolled compared to usual care (225 [11.8%] vs. 169 [5.8%]; OR=2.2, 95% CI=1.8-2.7), with increases up to 23.4% enrollment in 2014 (vs. average enrollment rate of 5.9% under usual referral). Patients who enrolled following automatic referral were significantly younger and more often employed (both P<0.001); no other differences were observed. Conclusion: In a lower-resource, Southeast Asian setting, automatic CR referral is associated with over two times greater enrollment in phase 2 CR, although efforts to maintain this effect are required.
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Affiliation(s)
| | - Sherry L. Grace
- York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada
| | - Lucky R. Cuenza
- Section of Cardiac Rehabilitation, Philippine Heart Center, Quezon City, Philippines
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18
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Garfein J, Guhl EN, Swabe G, Sekikawa A, Barinas-Mitchell E, Forman DE, Magnani JW. Racial and Ethnic Differences in Cardiac Rehabilitation Participation: Effect Modification by Household Income. J Am Heart Assoc 2022; 11:e025591. [PMID: 35730601 PMCID: PMC9333381 DOI: 10.1161/jaha.122.025591] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Cardiac rehabilitation (CR) is associated with improved cardiovascular outcomes. Racial and ethnic differences in CR have been identified, but whether income may attenuate these disparities remains unknown. We evaluated (1) racial/ethnic differences in CR participation in a contemporary sample of insured US adults, and (2) assessed how household income modifies associations between race or ethnicity and CR participation. Methods and Results We identified 107 199 individuals with a CR‐qualifying diagnosis between January 1, 2016 and December 31, 2018 in Optum’s de‐identified Clinformatics database. We evaluated associations between race or ethnicity and participation in CR, and assessed interaction between race or ethnicity and annual household income. The mean±SD age of all participants was 70.4±11.6 years; 37.4% were female and 76.0% were White race. Overall, 28 443 (26.5%) attended ≥1 CR sessions. After adjustment, compared with White individuals, the probability of attending CR was 31% lower for Asian individuals (95% CI, 27%–36%), 19% lower for Black individuals (95% CI, 16%–22%), and 43% lower for Hispanic individuals (95% CI, 40%–45%), all P<0.0001. The time to CR attendance was also significantly longer for Asian, Black, and Hispanic individuals. Associations between race or ethnicity and attendance at CR differed significantly across household income categories (P interaction=0.0005); however, Asian, Black, and Hispanic individuals were less likely to attend CR at all incomes. Conclusions In a geographically and racially diverse cohort, participation in CR was low overall, and was lowest among Asian, Black, and Hispanic candidates. Household income may impact the link between race or ethnicity and attendance at CR, but substantial racial and ethnic disparities exist across incomes.
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Affiliation(s)
- Joshua Garfein
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Emily N Guhl
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Gretchen Swabe
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Daniel E Forman
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Jared W Magnani
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
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19
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Simões VAL, Mendes FDSNS, Avellar AM, da Silva GMS, Carneiro FM, Silva PS, Mazzoli-Rocha F, Silva RS, Vieira MC, Costa CJDN, de Sousa AS, Rosalino CMV, Nobre PFDS, de Holanda MT, Costa HS, Saraiva RM, Hasslocher-Moreno AM, Castro R, Mediano MFF. Cost-effectiveness of an exercise-based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study. Trop Med Int Health 2022; 27:630-638. [PMID: 35644993 DOI: 10.1111/tmi.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). METHODS Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by β coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). RESULTS The intervention group presented higher costs with healthcare visits (β = +3317.3; p < 0.001), hospitalisation (β = +2810.4; p = 0.02) and total cost (β = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (β = +2455.8; p < 0.001) and total cost (β = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg-1 min-1 of VO2peak . CONCLUSIONS The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.
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Affiliation(s)
| | | | - Alexandre Monken Avellar
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Fernanda Martins Carneiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paula Simplício Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rudson Santos Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marcelo Carvalho Vieira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Centre for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, Brazil
| | | | - Andrea Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | - Henrique Silveira Costa
- Department of Physical Therapy, Faculty of Healthy and Biological Sciences, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Rodolfo Castro
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Institute of Collective Health, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Brazil
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20
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Rangel-Cubillos DM, Vega-Silva AV, Corzo-Vargas YF, Molano-Tordecilla MC, Peñuela-Arévalo YP, Lagos-Peña KM, Jácome-Hortúa AM, Villamizar-Jaimes CJ, Grace SL, Dutra de Souza HC, Angarita-Fonseca A, Sánchez-Delgado JC. Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041911. [PMID: 35206100 PMCID: PMC8872241 DOI: 10.3390/ijerph19041911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 01/27/2023]
Abstract
Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.
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Affiliation(s)
- Diana Marcela Rangel-Cubillos
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Andrea Vanessa Vega-Silva
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Yully Fernanda Corzo-Vargas
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Maria Camila Molano-Tordecilla
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Yesica Paola Peñuela-Arévalo
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Karen Mayerly Lagos-Peña
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Adriana Marcela Jácome-Hortúa
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | | | - Sherry L. Grace
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada;
- KITE-Toronto Rehab Institute, & Director of Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M4G 1R7, Canada
| | - Hugo Celso Dutra de Souza
- Laboratory of Physiology and Cardiovascular Physioterapy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Correspondence: (H.C.D.d.S.); or (J.C.S.-D.)
| | - Adriana Angarita-Fonseca
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
- Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, QC J9X 5E4, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Juan Carlos Sánchez-Delgado
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
- Laboratory of Physiology and Cardiovascular Physioterapy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Grupo de Investigación Ser Cultura y Movimiento, Universidad Santo Tomás-Bucaramanga, Santander 680001, Colombia
- Correspondence: (H.C.D.d.S.); or (J.C.S.-D.)
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Komiyama J, Iwagami M, Mori T, Kuroda N, Jin X, Ito T, Tamiya N. Factors Associated with Outpatient Cardiac Rehabilitation Participation in Older Patients: A Population-Based Study Using Claims Data from Two Cities in Japan. ANNALS OF CLINICAL EPIDEMIOLOGY 2022; 4:11-19. [PMID: 38505282 PMCID: PMC10760477 DOI: 10.37737/ace.22003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/09/2021] [Indexed: 03/21/2024]
Abstract
BACKGROUND Although outpatient cardiac rehabilitation has been shown to be effective, the participation status of older cardiac patients is unclear in real-world settings. We investigated the proportion and associated factors of outpatient cardiac rehabilitation participation among older patients with heart diseases after cardiac intervention. METHODS We analyzed data from medical and long-term care insurance claims data from two municipalities in Japan. The data coverage period was between April 2014 and March 2019 in City A and between April 2012 and November 2016 in City B. We identified patients aged ≥65 years with post-operative acute myocardial infarction, angina pectoris, or heart valve disease. We estimated the proportion of cardiac rehabilitation participation and conducted logistic regression to identify factors (age, sex, type of cardiac disease, open-heart surgery, Charlson comorbidity index, long-term care need level, catecholamine use, inpatient cardiac rehabilitation, and hospital volume for cardiac rehabilitation) associated with outpatient cardiac rehabilitation participation. RESULTS A total of 690 patients were included in this study. The proportion of patients receiving outpatient cardiac rehabilitation was 9.0% overall. Multivariable logistic regression analysis suggested that men (adjusted OR 3.98; 95% CI 1.69-9.37), acute myocardial infarction (adjusted OR 2.76; 95% CI 1.20-6.36; reference angina pectoris), inpatient cardiac rehabilitation (adjusted OR 17.01; 95% CI 5.33-54.24), and "hospital volume" for cardiac rehabilitation (adjusted OR 4.35; 95% CI 1.14-16.57 for high-volume hospitals; reference low-volume hospital) were independently associated with outpatient cardiac rehabilitation. CONCLUSIONS The participation rate of outpatient cardiac rehabilitation among older post-operative cardiac patients was suboptimal. Further studies are warranted to examine its generalizability and whether a targeted approach to a group of patients who are less likely to receive outpatient cardiac rehabilitation could improve the participation rate.
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Affiliation(s)
- Jun Komiyama
- Graduate school of Comprehensive Human Sciences, University of Tsukuba
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
| | - Takahiro Mori
- Health Services Research and Development Center, University of Tsukuba
- Department of General Internal Medicine, Eastern Chiba Medical Center
| | - Naoaki Kuroda
- Health Services Research and Development Center, University of Tsukuba
- Department of Public Health and Welfare, Tsukuba City
- Community Clinic Tsukuba
| | - Xueying Jin
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
| | - Tomoko Ito
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
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Pitta NC, Furuya RK, Freitas NDO, Dessotte CAM, Dantas RAS, Ciol MA, Schmidt A, Rossi LA. Effect of an educational program on physical activity in individuals undergoing their first percutaneous coronary intervention: A randomized clinical trial. Braz J Phys Ther 2022; 26:100443. [PMID: 36206592 PMCID: PMC9539789 DOI: 10.1016/j.bjpt.2022.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 08/07/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Educational programs designed for specific populations to improve regular physical activity need to be tested. OBJECTIVES To evaluate the effectiveness of an educational program, when compared to usual care, on improving physical activity 5 to 7 months after hospital discharge in adult patients undergoing their first percutaneous coronary intervention. METHODS Randomized controlled trial with two groups: usual care (n = 56) and educational program (n = 53) interventions. Data on sociodemographic and clinical characteristics were collected and the Baecke-Habitual Physical Activity Questionnaire, Self-efficacy Scale for Physical Activity, and Hospital Anxiety and Depression Scale were administered at baseline and follow-up. Participants in the educational program received an intervention based on Social Cognitive Theory, focused on physical activity, followed by three telephone calls. The usual care group received the hospital routine information. Unadjusted and adjusted differences between the two groups in mean score changes (with 95% confidence intervals [CI]) were calculated for all outcomes. RESULTS At follow-up, the educational program group showed higher mean ± standard deviation scores than the usual care group for practice of physical activity (7.94 ± 1.84 vs. 6.90 ± 1.89) and for self-efficacy (3.98 ± 3.75 vs. 2.52 ± 3.12). Adjusting for baseline outcome, the difference in mean change between groups was 0.89 (95% CI: 0.32, 1.46) for physical activity and 2.30 (95% CI: 1.12, 3.49) for self-efficacy. There were no statistical differences between groups in symptoms of anxiety and depression. CONCLUSION The educational program may be an effective intervention in increasing habitual physical activity and self-efficacy for physical activity in individuals with coronary artery disease.
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Affiliation(s)
- Natássia Condilo Pitta
- Postgraduate Program in Fundamental Nursing, Ribeirão Preto College of Nursing, Universidade de São Paulo, Bairro Quinta da Primavera, Avenida Luiz Octávio da Silva Whitaker 1550, Comp. 2303, Ribeirão Preto, SP CEP 14022-098, Brazil.
| | - Rejane Kiyomi Furuya
- Paraná Federal Institute of Education, Science and Technology, Federal Institute of Paraná, Londrina, PR, Brazil
| | | | - Carina Aparecida Marosti Dessotte
- General and Specialised Nursing Department, Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Rosana Aparecida Spadoti Dantas
- General and Specialised Nursing Department, Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcia Aparecida Ciol
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, United States
| | - André Schmidt
- Department of Internal Medicine, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Lidia Aparecida Rossi
- General and Specialised Nursing Department, Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Borges GLB, da Cruz MMA, Ricci-Vitor AL, da Silva PF, Grace SL, Vanderlei LCM. Publicly versus privately funded cardiac rehabilitation: access and adherence barriers. A cross-sectional study. SAO PAULO MED J 2022; 140:108-114. [PMID: 35043870 PMCID: PMC9623829 DOI: 10.1590/1516-3180.2020.0782.r1.31052021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges. OBJECTIVE To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence. DESIGN AND SETTING Observational, cross-sectional study in public and private CR programs offered in Brazil. METHODS Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale. RESULTS From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012). CONCLUSION Publicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.
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Affiliation(s)
- Giovanna Lombardi Bonini Borges
- PT. Physiotherapist, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
| | - Mayara Moura Alves da Cruz
- PT, MSc. Physiotherapist and Doctoral Student, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
| | - Ana Laura Ricci-Vitor
- PT, PhD. Professor, Escola Superior de Saúde Egas Moniz (ESSEM), Egas Moniz - Cooperativa de Ensino Superior (CRL), Almada, Setúbal, Portugal.
| | - Paula Fernanda da Silva
- PT. Physiotherapist and Master's Student, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
| | - Sherry Lynn Grace
- PhD, CRFC. Professor, Faculty of Health, York University, Toronto, Ontario, Canada; and Senior Scientist, KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Luiz Carlos Marques Vanderlei
- PhD. Professor, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
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Refaat Ahmed F, Gamil Abdelhamid R, Hamdi El-Soussi A, Eid AbuRuz M, Arsyed Subu M, Maria Dias J, Ibrahim Sanhoury M. Barriers to cardiac rehabilitation-physical activities practices: An observational descriptive study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Outcomes of a smartphone-based application with live health-coaching post-percutaneous coronary intervention. EBioMedicine 2021; 72:103593. [PMID: 34657825 PMCID: PMC8577401 DOI: 10.1016/j.ebiom.2021.103593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background The interval between inpatient hospitalization for symptomatic coronary artery disease (CAD) and post-discharge office consultation is a vulnerable period for adverse events. Methods Content was customized on a smartphone app-based platform for hospitalized patients receiving percutaneous coronary intervention (PCI) which included education, tracking, reminders and live health coaches. We conducted a single-arm open-label pilot study of the app at two academic medical centers in a single health system, with subjects enrolled 02/2018–05/2019 and 1:3 propensity-matched historical controls from 01/2015–12/2017. To evaluate feasibility and efficacy, we assessed 30-day hospital readmission (primary), outpatient cardiovascular follow-up, and cardiac rehabilitation (CR) enrollment as recorded in the health system. Outcomes were assessed by Cox Proportional Hazards model. Findings 118 of 324 eligible (36·4%) 21–85 year-old patients who underwent PCI for symptomatic CAD who owned a smartphone or tablet enrolled. Mean age was 62.5 (9·7) years, 87 (73·7%) were male, 40 of 118 (33·9%) had type 2 diabetes mellitus, 68 (57·6%) enrolled underwent PCI for MI and 59 (50·0%) had previously known CAD; demographics were similar among matched historical controls. No significant difference existed in all-cause readmission within 30 days (8·5% app vs 9·6% control, ARR -1.1% absolute difference, 95% CI -7·1–4·8, p = 0·699) or 90 days (16·1% app vs 19·5% control, p = 0.394). Rates of both 90-day CR enrollment (HR 1·99, 95% CI 1·30–3·06) and 1-month cardiovascular follow up (HR 1·83, 95% CI 1·43–2·34) were greater with the app. Weekly engagement at 30- and 90-days, as measured by percentage of weeks with at least one day of completion of tasks, was mean (SD) 73·5% (33·9%) and 63·5% (40·3%). Spearman correlation analyses indicated similar engagement across age, sex, and cardiovascular risk factors. Interpretations A post-PCI smartphone app with live health coaches yielded similarly high engagement across demographics and safely increased attendance in cardiac rehabilitation. Larger prospective randomized controlled trials are necessary to test whether this app improves cardiovascular outcomes following PCI. Funding National Institutes of Health, Boston Scientific. Clinical trial registration NCT03416920 (https://clinicaltrials.gov/ct2/show/NCT03416920).
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Chacin-Suarez A, Grace SL, Anchique-Santos C, Supervia M, Turk-Adawi K, Britto RR, Scantlebury DC, Araya-Ramirez F, Gonzalez G, Benaim B, Fernandez R, Hol J, Burdiat G, Salmon R, Lomeli H, Mamataz T, Medina-Inojosa JR, Lopez-Jimenez F. Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A Global Comparison. Am Heart J 2021; 240:16-27. [PMID: 34058163 DOI: 10.1016/j.ahj.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/20/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. METHODS In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. RESULTS ≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). CONCLUSION In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.
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Affiliation(s)
| | - Sherry L Grace
- York University & University Health Network (KITE & Peter Munk Cardiac Centre), University of Toronto, Canada
| | | | - Marta Supervia
- Mayo Clinic, Rochester, MN; Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | | | | | | | | | - Briseida Benaim
- Asociación Cardiovascular Centro-occidental (ASCARDIO), Barquisimeto, Venezuela
| | | | | | | | | | - Hermes Lomeli
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, México
| | - Taslima Mamataz
- York University & University Health Network (KITE & Peter Munk Cardiac Centre), University of Toronto, Canada
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Abstract
PURPOSE OF REVIEW Cardiac rehabilitation (CR) is grossly under-utilized. This review summarizes current knowledge about degree of CR utilization, reasons for under-utilization, and strategies to increase use. RECENT FINDINGS ICCPR's global CR audit quantified for the first time the number of additional CR spots needed per year to treat indicated patients, so there are programs they may use. The first randomized trial of automatic/systematic CR referral has shown it results in significantly greater patient completion. Moreover, the recent update of the Cochrane review on interventions to increase use has provided unequivocal evidence on the significant impact of clinician CR encouragement at the bedside; a course is now available to train clinicians. The USA is leading the way in implementing automatic referral with inpatient-clinician CR discussions. Suggestions to triage patients based on risk to less resource-intensive, unsupervised program models could simultaneously expand capacity and support patient adherence.
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Affiliation(s)
- Sherry L Grace
- Faculty of Health, York University, 4700 Keele Street, Toronto, Canada. .,KITE-Toronto Rehabilitation Institute, Toronto, ON, Canada. .,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Mary A Whooley
- US Department of Veterans Affairs Quality Enhancement Research Initiative, San Francisco, USA.,University of California, San Francisco, USA
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Ghisi GLDM, Seixas MB, Pereira DS, Cisneros LL, Ezequiel DGA, Aultman C, Sandison N, Oh P, da Silva LP. Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health 2021; 21:1236. [PMID: 34174860 PMCID: PMC8236150 DOI: 10.1186/s12889-021-11300-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Globally, the incidence of diabetes is increasing and strategies to reach a comprehensive approach of care are needed, including education in self-management. This is particularly true in low and middle-income countries where the number of people living with diabetes is higher than in the high-income ones. This article describes the development of a structured patient education program for Brazilians living with diabetes or prediabetes. Methods These steps were undertaken: 1) a 4-phase needs assessment (literature search of local diabetes guidelines, environmental scan, evaluation of information needs of patients identified by diabetes experts, and patient focus groups); and, 2) the translation and cultural adaptation of the patient guide (preparation, translation, back-translation, back-translation review, harmonization, and proofreading). Results Four of the seven guidelines identified include educational aspects of diabetes management. No structured education program was reported from the environmental scan. Regarding the information needs, 15 diabetes experts identified their patients’ needs, who referred that they have high information needs for topics related to their health condition. Finally, results from six patient focus groups were clustered into six themes (self-management, physical activity, eating habits, diabetes medication, psychosocial being, and sleep), all embedded into the new education program. Constructive theory, adult learning principles, and the Health Action Process Approach model were used in program development and will be used in delivery. The developed program consists of 18 educational sessions strategically mapped and sequenced to support the program learning outcomes and a patient guide with 17 chapters organized into five sections, matched with weekly lectures. Conclusions This program is a sequential and theoretical strategic intervention that can reach programs in Brazil to support diabetes and prediabetes patient education. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11300-y.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Mariana Balbi Seixas
- Faculty of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora, MG, 36038-330, Brazil
| | - Daniele Sirineu Pereira
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, 31270-901, MG, Brazil
| | - Ligia Loiola Cisneros
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, 31270-901, MG, Brazil
| | | | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Nicole Sandison
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Lilian Pinto da Silva
- Faculty of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora, MG, 36038-330, Brazil.
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Exposito Ordóñez E, Roldán Conesa D, Vicente Vera T. Prognostic effects of cardiovascular rehabilitation: facts and myths. Panminerva Med 2021; 63:160-169. [PMID: 33755389 DOI: 10.23736/s0031-0808.21.04267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since CR was introduced, studies have been carried out to discover the effect of CRHPs on cardiovascular morbidity and mortality and on heart-disease patients' quality of life. The first meta-analyses showed improvement in cardiovascular morbidity and mortality, although the studies were conducted in the coronary pre-reperfusion era, before the generalized use in secondary prevention of drugs such as statins, beta-blockers, or renin-angiotensin-system inhibitors, which have produced a decrease in cardiovascular mortality. In Europe, analyzing 25 studies with more than 200,000 patients. It concluded that, in spite of the great heterogeneity of the programs, CR clearly decreases mortality after ACS. Nevertheless, a strategy of CRHP standardization and evaluation is needed. In 2017, a study was carried out in our hospital to evaluate the effectiveness of multidisciplinary CRHP intervention on cardiovascular morbidity and mortality, recurrence of cardiovascular events, the control of RFCV and lifestyle changes in patients after ACS. A total of 442 patients were included who had presented an acute cardiovascular event in the previous six months; 306 patients from the CR group and 136 others with standard cardiology follow-up were used as controls. 405 patients completed follow-up for a median of 60 months. Compared to the usual treatments in cardiology, the patients who underwent CRHPs presented fewer readmissions for cardiovascular reasons (17% vs. 43.38%, P<0.001), fewer major cardiovascular events (11.9% vs. 27.2%, P<0.001) and new revascularizations (9.3% vs. 21.32%, P=0.001), with lower cardiovascular mortality (0 vs. 2.2%, P=0.014). It also led to better control of the RFCV (66% vs. 19.85%, P<0.001) and favored lifestyle changes in these patients (91% vs. 61%, P<0.001). Therefore, in our setting, the performance of CRHPs was shown to be effective in reducing cardiovascular morbidity and mortality and in the secondary prevention of coronary patients.
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Affiliation(s)
| | - Diego Roldán Conesa
- Cardiac Rehabilitation Unit, Reina Sofia de Murcia University Hospital, Murcia, Spain
| | - Tomás Vicente Vera
- Cardiac Rehabilitation Unit, Reina Sofia de Murcia University Hospital, Murcia, Spain - .,Catholic University of San Antonio de Murcia, Department of Cardiology, Reina Sofia de Murcia University Hospital, Murcia, Spain
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Gong X, Zhang W, Ripley-Gonzalez JW, Liu Y, Dun Y, Zheng F, Qiu L, Liu S. Successful Implementation and Development of a Phase II Cardiac Rehabilitation Program: A China-Wide Cross-Sectional Study Tracking In-service Training Clinical Staff. Front Public Health 2021; 9:639273. [PMID: 33816424 PMCID: PMC8009984 DOI: 10.3389/fpubh.2021.639273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the benefits of cardiac rehabilitation (CR), phase II CR remains highly unavailable; the factors influential to the successful implementation and development of phase II CR programs have not been fully explored. Methods: A cross-sectional survey was completed by 168 nationwide clinical staff. Parameters associated with the successful implementation and development of phase II CR and the factors associated with the quality of CR were explored by multivariable logistic regression. Results: One hundred and eighteen of 168 respondents' institutions had successfully developed phase II CR programs, 41 of which delivered high-quality CR. Independent factors associated with successful implementation and development of CR were leadership support from hospital administrators, support from resident physicians, staff perception in CR increasing medical risk, and department type (cardiology vs. rehabilitation department). Independent factors associated with CR quality were the availability of “professional CR providers” and staff perceptions of CR improving physician–patient relationships. The medical system factors did not affect the development and quality of CR, including hospital level, funding type, academic type, general/specialized hospital, located city, medical insurance, the existence of a CR outpatient clinic and independent space, the availability of professional CR providers, staff structure, and the availability of regular training and standard procedure. Conclusions: The development and quality of a phase II CR program may benefit from factors including support from administrators and resident physicians, adequately training more CR providers, without viewing medical system factors as a major issue.
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Affiliation(s)
- Xun Gong
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Wenliang Zhang
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Jeffrey W Ripley-Gonzalez
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Yuan Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China.,Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Fan Zheng
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Ling Qiu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
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Review of Trials on Exercise-Based Rehabilitation Interventions Following Acute Decompensated Heart Failure: OBSERVATIONS FROM THE WHO INTERNATIONAL CLINICAL TRIALS REGISTRY PLATFORM. J Cardiopulm Rehabil Prev 2021; 41:214-223. [PMID: 34158455 DOI: 10.1097/hcr.0000000000000583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiac rehabilitation is an important intervention for patients with heart failure. However, its clinical application in acute decompensated heart failure (ADHF) remains underutilized with limited research available. An assessment of current research in this area will help guide future investigations. The aim of this review is to summarize the current research focusing on rehabilitation interventions following recovery from ADHF. REVIEW METHODS A systematic search was carried out on all trials registered in the clinical trial registry database of the World Health Organization-International Clinical Trial Registry Platform (WHO-ICTRP). Studies focusing on ADHF and utilizing any exercise and rehabilitation-based intervention were included. RESULTS A majority of 11 trial protocols, including 3827 participants with low ejection fraction (<40%), were identified from the WHO-ICTRP database. Majority of the protocols (64%) focused on exercise-based interventions with approximately one-quarter (29%) focusing on neuromuscular electrical stimulation and one on noninvasive ventilation during exercise. Irrespective of the mode of exercise, all protocols employed low-moderate intensity training with outcomes focusing on physical function and quality of life. CONCLUSION Studies on rehabilitative interventions for ADHF are still in their early stages. More research is needed using innovative methodologies and testing for feasibility and fidelity.
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Vanzella LM, Oh P, Pakosh M, Ghisi GLM. Barriers to Cardiac Rehabilitation in Ethnic Minority Groups: A Scoping Review. J Immigr Minor Health 2021; 23:824-839. [DOI: 10.1007/s10903-021-01147-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/21/2022]
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Health Care Administrators' Cardiac Rehabilitation Attitudes (HACRA) in North and South America and the Development of a Scale to Assess Them. Heart Lung Circ 2020; 29:e111-e120. [DOI: 10.1016/j.hlc.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/19/2019] [Accepted: 09/11/2019] [Indexed: 12/16/2022]
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