1
|
Westerdahl E, Bergh C, Urell C. Patient-reported physical activity, pain, and fear of movement after cardiac surgery: a descriptive cross-sectional study. SCAND CARDIOVASC J 2024; 58:2393311. [PMID: 39158171 DOI: 10.1080/14017431.2024.2393311] [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: 01/03/2024] [Revised: 07/15/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES After cardiac surgery, there may be barriers to being physically active. Patients are encouraged to gradually increase physical activity, but limited knowledge exists regarding postoperative physical activity levels. This study aimed to assess patient-reported physical activity six months after cardiac surgery, determine adherence to WHO's physical activity recommendations, and explore potential relationships between pain, dyspnea, fear of movement, and activity levels. METHODS The study design was a cross-sectional study at Örebro University Hospital, Sweden. Preoperative and surgical data were retrieved from medical records and questionnaires concerning physical activity (Frändin-Grimby Activity Scale, the Physical activity Likert-scale Haskell, Patient-Specific Functional Scale, and Exercise Self-efficacy Scale) were completed six months after surgery. Data were collected on pain, dyspnea, general health status and kinesiophobia i.e. fear of movement, using the Tampa Scale of Kinesiophobia Heart. RESULTS In total, 71 patients (68 ± 11 years, males 82%) participated in this study. Most patients (76%) reported a light to moderate activity level (Frändin-Grimby levels 3-4) six months after cardiac surgery. In total, 42% of the patients adhered to the WHO's physical activity recommendations (150 min/week). Pain and dyspnea were low. Patients with lower activity levels exhibited significantly higher levels of fear of movement (p =.025). CONCLUSIONS The majority of patients reported engaging in light to moderate activity levels six months after cardiac surgery. Despite this, less than half of the patients met the WHO's physical activity recommendations. Potential barriers to physical activity such as pain, dyspnea and fear of movement were reported to be low.
Collapse
Affiliation(s)
- Elisabeth Westerdahl
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Cecilia Bergh
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Charlotte Urell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
2
|
Zhou M, Xu Y, Zhang L, Yang Y, Zheng J. Effectiveness of smartphone-assisted cardiac rehabilitation: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:3256-3265. [PMID: 37559408 DOI: 10.1080/09638288.2023.2244883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To explore the effectiveness of smartphone-assisted home cardiac rehabilitation and whether it can be used as a remote detection method to promote home cardiac rehabilitation. METHODS Four databases were searched to collect randomized controlled trials (RCTs) about smartphone-assisted cardiac rehabilitation. The Cochrane risk-of-bias tool was used to assess the methodological quality of the included studies. Two independent investigators performed the literature screening, information extraction, and risk of bias assessment. Any disagreements were resolved by a third investigator. Meta-analysis and systematic review were performed. Sensitivity analysis and subgroup analysis were carried out to explore the sources of heterogeneity. RESULTS A total of 14 RCTs involving 1962 patients were included. Meta-analysis showed that compared with conventional cardiac rehabilitation/usual care, smartphone-assisted cardiac rehabilitation significantly improved VO2peak in patients with cardiovascular disease (WMD= 1.32, 95%CI:0.82 to 1.81, p > 0.05) and enhanced their treatment compliance (RR = 1.62, 95%CI:1.21 to 2.17, p > 0.05). There were no significant differences in six-minute walk distance (WMD = 12.88, 95%CI:-0.82 to 26.57, p > 0.05), body mass index (BMI) (WMD=-0.14, 95%CI:-0.34 to 0.06, p > 0.05), life quality, psychological status, and other cardiovascular risks. CONCLUSION Smartphone-assisted cardiac rehabilitation showed significant improvement in exercise capacity and treatment compliance in patients with cardiac rehabilitation but did not improve BMI, quality of life, psychological status, or reduce other cardiovascular risks. Smartphone-based cardiac rehabilitation is increasingly used as a remote detection method for cardiac rehabilitation in middle-income countries, which provides new insights into home cardiac rehabilitation.
Collapse
Affiliation(s)
- Meimei Zhou
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
| | - Youkang Xu
- Department of Osteoarthropathy Rehabilitation, The Second Rehabilitation Hospital of Shanghai, P.R. China
| | - Lili Zhang
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
| | - Yushan Yang
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
| | - Jiejiao Zheng
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
| |
Collapse
|
3
|
Beleigoli A, Dafny HA, Pinero de Plaza MA, Hutchinson C, Marin T, Ramos JS, Suebkinorn O, Gebremichael LG, Bulamu NB, Keech W, Ludlow M, Hendriks J, Versace V, Clark RA. Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study. Clin Rehabil 2024; 38:837-854. [PMID: 38631370 PMCID: PMC11059835 DOI: 10.1177/02692155241236998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/07/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. DESIGN We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. SETTING Economically disadvantaged areas in rural Australia. PARTICIPANTS Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. MAIN MEASURES A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). RESULTS Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. CONCLUSIONS Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.
Collapse
Affiliation(s)
- Alline Beleigoli
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Hila Ariela Dafny
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Tania Marin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Joyce S. Ramos
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Orathai Suebkinorn
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lemlem G. Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Norma B. Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Marie Ludlow
- Heart Foundation of Australia, Adelaide, Australia
| | - Jeroen Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Robyn A. Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| |
Collapse
|
4
|
Peinado-Rubia AB, Verdejo-Herrero A, Obrero-Gaitán E, Osuna-Pérez MC, Cortés-Pérez I, García-López H. Non-Immersive Virtual Reality-Based Therapy Applied in Cardiac Rehabilitation: A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2024; 24:903. [PMID: 38339621 PMCID: PMC10857255 DOI: 10.3390/s24030903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The aim of this systematic review with meta-analysis was to assess the effectiveness of non-immersive virtual reality (niVR) active videogames in patients who underwent cardiac rehabilitation (CR). METHODS A systematic review with meta-analysis, according to the PRISMA guidelines and previously registered in PROSPERO (CRD42023485240), was performed through a literature search in PubMed (Medline), SCOPUS, WOS, and PEDro since inception to 21 November 2023. We included randomized controlled trials (RCTs) that assessed the effectiveness of an niVR intervention, in comparison with conventional CR and usual care, on aerobic capacity and cardiovascular endurance (physical function), anxiety, depression, and quality of life (QoL). The risk of bias in individual studies was assessed using the Cochrane risk of bias tool. Effect size was estimated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. RESULTS Nine RCT that met the inclusion criteria were included in the meta-analysis. The meta-analysis showed a moderate-to-large effect favoring niVR active videogames included in CR in increasing aerobic capacity and cardiovascular endurance (SMD = 0.74; 95% CI 0.11 to 1.37; p = 0.021) and reducing anxiety (SMD = -0.66; 95% CI -1.13 to -0.2; p = 0.006). Only 4.8% of patients reported adverse events while performing niVR active videogames. CONCLUSIONS Inclusion of niVR active videogames in CR programs is more effective than conventional CR in improving aerobic capacity and cardiovascular endurance and in reducing anxiety.
Collapse
Affiliation(s)
- Ana Belén Peinado-Rubia
- Asociación de Fibromialgia de Jaén (AFIXA), C/Baltasar de Alcázar 5, 23008 Jaén, Spain;
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - Alberto Verdejo-Herrero
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Ctra. Sacramento s/n, 04120 Almería, Spain; (A.V.-H.); (H.G.-L.)
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - Héctor García-López
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Ctra. Sacramento s/n, 04120 Almería, Spain; (A.V.-H.); (H.G.-L.)
| |
Collapse
|
5
|
Oehler AC, Holmstrand EC, Zhou L, Harzand A, Vathsangam H, Kendall K, Gabriel G, Murali S. Cost Analysis of Remote Cardiac Rehabilitation Compared With Facility-Based Cardiac Rehabilitation for Coronary Artery Disease. Am J Cardiol 2024; 210:266-272. [PMID: 37973439 DOI: 10.1016/j.amjcard.2023.08.061] [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: 06/29/2023] [Accepted: 08/14/2023] [Indexed: 11/19/2023]
Abstract
Remote cardiac rehabilitation (RCR) represents a promising, noninferior alternative to facility-based cardiac rehabilitation (FBCR). The comparable cost of RCR in US populations has yet to be extensively studied. The purpose of this prospective, patient-selected study of traditional FBCR versus a third-party asynchronous RCR platform was to assess whether RCR can be administered at a comparable cost and clinical efficacy to FBCR. Adult insured patients were eligible for enrollment after an admission for a coronary heart disease event. Patients selected either FBCR or Movn RCR, a 12-week telehealth intervention using an app-based platform and internet-capable medical devices. Clinical demographics, intervention adherence, cost-effectiveness, and hospitalizations at 1-year after enrollment were assessed from the Highmark claims database after propensity matching between groups. A total of 260 patients were included and 171 of those eligible (65.8%) received at least 1 cardiac rehabilitation session and half of the patients chose Movn RCR. The propensity matching produced a sample of 41 matched pairs. Movn RCR led to a faster enrollment and higher completion rates (80% vs 50%). The total medical costs were similar between Movn RCR and FBCR, although tended toward cost savings with Movn RCR ($10,574/patient). The cost of cardiac rehabilitation was lower in those enrolled in Movn RCR ($1,377/patient, p = 0.002). The all-cause and cardiovascular-related hospitalizations or emergency department visits in the year after enrollment in both groups were similar. In conclusion, this pragmatic study of patients after a coronary heart disease event led to equivalent total medical costs and lower intervention costs for an asynchronous RCR platform than traditional FBCR while maintaining similar clinically important outcomes.
Collapse
Affiliation(s)
- Andrew C Oehler
- Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
| | | | - Lulu Zhou
- Evaluation Analytics, Highmark Health, Pittsburgh, Pennsylvania
| | | | - Harshvardhan Vathsangam
- Movn Health, Irvine, California; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kellee Kendall
- VITAL Innovation Program, Highmark Health, Pittsburgh, Pennsylvania
| | - George Gabriel
- Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Srinivas Murali
- Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Popovici M, Ursoniu S, Feier H, Mocan M, Tomulescu OMG, Kundnani NR, Valcovici M, Dragan SR. Benefits of Using Smartphones and Other Digital Methods in Achieving Better Cardiac Rehabilitation Goals: A Systematic Review and Meta-Analysis. Med Sci Monit 2023; 29:e939132. [PMID: 37143317 PMCID: PMC10167866 DOI: 10.12659/msm.939132] [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: 12/02/2022] [Accepted: 02/22/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The importance of introducing digital technology as an alternative to classical cardiac rehabilitation has been discussed in several reviews. The purpose of this systematic review and meta-analysis was to analyze the effectiveness of digital technology use in cardiac rehabilitation to determine whether digital methods like use of smartphones, compared to traditional rehabilitation methods, can improve the overall quality of life and exercise capacity of cardiac patients. MATERIAL AND METHODS PubMed, EMBASE, and ScienceDirect were systematically searched in a randomized manner, resulting in 11 randomized controlled trials (RCTs) that met all the inclusion criteria. The inclusion criteria were patients with coronary heart disease, valvular surgery, or post- myocardial revascularization that were in a technology-assisted cardiac rehabilitation program vs traditional standard physical follow-up protocol. RESULTS Seven eligible trials including a total of 802 participants examined the effect of interventions on VO2 peak. One of the studies comprised 2-stage analysis for this parameter. We found that VO₂ peak was significantly higher in the intervention group. Three studies analyzed the 6-minute walk test (6MWT) results; significant differences were reported, with better results in the interventional group. CONCLUSIONS The results of our meta-analysis support conducting further randomized trials, considering that the development of technology is on the rise. In the past decade there has been an immense increase in the use of smartphones, which can widely be used in healthcare, with promising benefits in having efficient home-based monitoring of the patients and in reducing financial burden.
Collapse
Affiliation(s)
- Miruna Popovici
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorin Ursoniu
- Department of Functional Sciences, Discipline of Public Health, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Horea Feier
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Mihaela Mocan
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Nilima Rajpal Kundnani
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Mihaela Valcovici
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Simona Ruxanda Dragan
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| |
Collapse
|
8
|
Blank L, Cantrell A, Sworn K, Booth A. Factors which facilitate or impede patient engagement with pulmonary and cardiac rehabilitation: a rapid evaluation mapping review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-59. [PMID: 37464900 DOI: 10.3310/klwr9463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background There is a considerable body of systematic review evidence considering the effectiveness of rehabilitation programmes on clinical outcomes. However, much less is known about effectively engaging and sustaining patients in rehabilitation. There is a need to understand the full range of potential intervention strategies. Methods We conducted a mapping review of UK review-level evidence published 2017-21. We searched MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health (CINAHL) and conducted a narrative synthesis. Included reviews reported factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation, or an intervention to facilitate these factors. Study selection was undertaken independently by two reviewers. Results In total, we identified 20 review papers that met our inclusion criteria. There was a bias towards reviews considering cardiac rehabilitation, with these numbering 16. An additional 11 unpublished interventions were also identified through internet searching of key websites. The reviews included 60 identifiable UK primary studies that considered factors which affected attendance at rehabilitation; 42 considered cardiac rehabilitation and 18 considering pulmonary rehabilitation. They reported on factors from the patients' point of view, as well as the views of professionals involved in referral or treatment. It was more common for factors to be reported as impeding attendance at rehabilitation rather than facilitating it. We grouped the factors into patient perspective (support, culture, demographics, practical, health, emotions, knowledge/beliefs and service factors) and professional perspective (knowledge: staff and patient, staffing, adequacy of service provision and referral from other services, including support and wait times). We found considerably fewer reviews (n = 3) looking at interventions to facilitate participation in rehabilitation. Although most of the factors affecting participation were reported from a patient perspective, most of the identified interventions were implemented to address barriers to access in terms of the provider perspective. The majority of access challenges identified by patients would not therefore be addressed by the identified interventions. The more recent unevaluated interventions implemented during the COVID-19 pandemic may have the potential to act on some of the patient barriers in access to services, including travel and inconvenient timing of services. Conclusions The factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation consist of a web of complex and interlinked factors taking into consideration the perspectives of the patients and the service providers. The small number of published interventions we identified that aim to improve access are unlikely to address the majority of these factors, especially those identified by patients as limiting their access. Better understanding of these factors will allow future interventions to be more evidence based with clear objectives as to how to address the known barriers to improve access. Limitations Time limitations constrained the consideration of study quality and precluded the inclusion of additional searching methods such as citation searching and contacting key authors. This may have implications for the completeness of the evidence base identified. Future work High-quality effectiveness studies of promising interventions to improve attendance at rehabilitation, both overall and for key patient groups, should be the focus moving forward. Funding This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HSDR programme or the Department of Health. Study registration The study protocol is registered with PROSPERO [CRD42022309214].
Collapse
Affiliation(s)
- Lindsay Blank
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katie Sworn
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
9
|
Zhou P, Zhang W, Kim Y, Meng H. Effects of Low- and High-Frequency Cardiac Rehabilitation on Risk Factors, Physical Fitness and Quality of Life in Middle-Aged Women with Coronary Heart Disease. Metabolites 2023; 13:metabo13040550. [PMID: 37110208 PMCID: PMC10143020 DOI: 10.3390/metabo13040550] [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: 01/13/2023] [Revised: 03/04/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiac rehabilitation (CR) is a system that comprehensively manages risk factors to reduce the recurrence rate after cardiovascular disease treatment. This study compared the effects of home-based low-frequency CR (1-2 times/week) and center-based high-frequency CR (3-5 times/week) for 12 weeks. This study was conducted as an observational case-control study. Ninety women, ages 45 to 60, who underwent coronary artery stenting were enrolled. Measurement variables were waist circumference, body mass index (BMI), blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG), glucose, VO2 peak, body composition, and quality of life. Significant changes were observed in systolic BP, TC, LDLC, TG, VO2 peak, exercise duration, and quality of life in both groups. However, BMI, waist circumference, body fat percentage, HDLC, and blood glucose only exhibited significant changes with HFT. The interaction effects according to time and group were as follows: systolic BP, waist circumference, body fat, BMI, HDLC, and glucose (p < 0.05). Therefore, in CR participants, HFT improved more than LFT on obesity factors, HDLC, and glucose change. As well as center-based HFT, home-based LFT also improved risk factors for cardiovascular disease, fitness, and quality of life. For female patients who have difficulty visiting the CR center frequently, home-based LFT may be a CR program that can be presented as an alternative.
Collapse
Affiliation(s)
- Peng Zhou
- Department of Physical Education, General Graduate School, Yongin University, Yongin 17092, Republic of Korea
| | - Wangyang Zhang
- School of Physical Education, Main Campus, Zhengzhou University, Zhengzhou 450001, China
| | - Yonghwan Kim
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Republic of Korea
| | - Huan Meng
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Republic of Korea
| |
Collapse
|
10
|
Lalande K, Bouchard K, Tulloch H. Cardiac rehabilitation: One size does not fit all. Int J Cardiol 2023; 379:134-135. [PMID: 36907455 DOI: 10.1016/j.ijcard.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Affiliation(s)
- K Lalande
- University of Ottawa Heart Institute, Ottawa, Canada,.
| | - K Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada,; University of Ottawa, Ottawa, Canada
| | - H Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada,; University of Ottawa, Ottawa, Canada
| |
Collapse
|
11
|
Faghy MA, Yates J, Hills AP, Jayasinghe S, da Luz Goulart C, Arena R, Laddu D, Gururaj R, Veluswamy SK, Dixit S, Ashton REM. Cardiovascular disease prevention and management in the COVID-19 era and beyond: An international perspective. Prog Cardiovasc Dis 2023; 76:102-111. [PMID: 36693488 PMCID: PMC9862672 DOI: 10.1016/j.pcad.2023.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-being is already clear. At a time when the global state of CVD is perilous, we provide a continental overview of prevalence data and initiatives that have positively influenced CVD outcomes. What is clear is that despite attempts to address the global burden of CVD, there remains a lack of collective thinking and approaches. Moving forward, a coordinated global infrastructure that, if developed with appropriate and relevant key stakeholders, could provide significant and longstanding benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical perspectives must be underpinned by unified approaches that maximize public health.
Collapse
Affiliation(s)
- Mark A Faghy
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - James Yates
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK
| | - Andrew P Hills
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Sisitha Jayasinghe
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Ross Arena
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
| | - Rachita Gururaj
- Department of Physiotherapy, Ramaiah Medical College, Bengaluru, India
| | - Sundar Kumar Veluswamy
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physiotherapy, Ramaiah Medical College, Bengaluru, India
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, King Khalid University, Saudi Arabia
| | - Ruth E M Ashton
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
| |
Collapse
|
12
|
Louis J, Bennett S, Owens DJ, Tiollier E, Brocherie F, Carneiro MAS, Nunes PRP, Costa B, Castro-e-Souza P, Lima LA, Lisboa F, Oliveira-Júnior G, Kassiano W, Cyrino ES, Orsatti FL, Bossi AH, Matta G, Tolomeu de Oliveira G, Renato Melo F, Rocha Soares E, Ocelli Ungheri B, Daros Pinto M, Nuzzo JL, Latella C, van den Hoek D, Mallard A, Spathis J, DeBlauw JA, Ives SJ, Ravanelli N, Narang BJ, Debevec T, Baptista LC, Padrão AI, Oliveira J, Mota J, Zacca R, Nikolaidis PT, Lott DJ, Forbes SC, Cooke K, Taivassalo T, Elmer SJ, Durocher JJ, Fernandes RJ, Silva G, Costa MJ. Commentaries on Viewpoint: Hoping for the best, prepared for the worst: can we perform remote data collection in sport sciences? J Appl Physiol (1985) 2022; 133:1433-1440. [PMID: 36509417 PMCID: PMC9762970 DOI: 10.1152/japplphysiol.00613.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Julien Louis
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sam Bennett
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
- Center for Biological Clocks Research, Department of Biology, Texas A&M University, College Station, Texas, United States
| | - Daniel J Owens
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Eve Tiollier
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Franck Brocherie
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Marcelo A. S. Carneiro
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
- Applied Physiology, Nutrition and Exercise Research Group, Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Uberaba, Brazil
| | - Paulo Ricardo P. Nunes
- Applied Physiology, Nutrition and Exercise Research Group, Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Uberaba, Brazil
- Department of Body and Human Movement, Minas Gerais State University (UEMG), Passos, Brazil
| | - Bruna Costa
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
| | - Pâmela Castro-e-Souza
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
| | - Luís A. Lima
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
| | - Felipe Lisboa
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
| | - Gersiel Oliveira-Júnior
- Applied Physiology, Nutrition and Exercise Research Group, Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Uberaba, Brazil
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Witalo Kassiano
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
| | - Edilson S. Cyrino
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
| | - Fábio L. Orsatti
- Applied Physiology, Nutrition and Exercise Research Group, Exercise Biology Research Lab (BioEx), Federal University of Triangulo Mineiro (UFTM), Uberaba, Brazil
| | - Arthur Henrique Bossi
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
- The Mountain Bike Centre of Scotland, Peel Tower, Peebles, United Kingdom
| | - Guilherme Matta
- School of Psychology and Life Sciences, Faculty of Science, Engineering and Social Sciences, Canterbury Christ Church University, Canterbury, United Kingdom
| | - Géssyca Tolomeu de Oliveira
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
- Aquatic Activities Research Group, Department of Physical Education, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Ferreira Renato Melo
- Aquatic Activities Research Group, Department of Physical Education, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Everton Rocha Soares
- Physical Evaluation and Resistance Training Research Group, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Bruno Ocelli Ungheri
- Leisure, Management and Policy Group, Department of Physical Education, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Matheus Daros Pinto
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - James L. Nuzzo
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Christopher Latella
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Neurophysiology Research Laboratory, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel van den Hoek
- School of Behavioural and Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Alistair Mallard
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Jemima Spathis
- School of Behavioural and Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Justin A. DeBlauw
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, New York, United States
| | - Stephen J. Ives
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, New York, United States
| | - Nicholas Ravanelli
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Benjamin J. Narang
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Department of Automatics, Biocybernetics, and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Tadej Debevec
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Department of Automatics, Biocybernetics, and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Liliana C. Baptista
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Ana Isabel Padrão
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - José Oliveira
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Jorge Mota
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Rodrigo Zacca
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | | | - Donovan J. Lott
- Department of Physical Therapy, University of Florida, Gainesville, Florida, United States
| | - Sean C. Forbes
- Department of Physical Therapy, University of Florida, Gainesville, Florida, United States
| | - Korey Cooke
- University of Florida Health Rehab Hospital, Gainesville, Florida, United States
| | - Tanja Taivassalo
- Department of Physiology and Aging, University of Florida, Gainesville, Florida, United States
| | - Steven J. Elmer
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
- Health Research Institute, Michigan Technological University, Houghton, Michigan, United States
| | - John J. Durocher
- Department of Biological Sciences, Integrative Human Health Program, Purdue University Northwest, Hammond, Indiana, United States
- Integrative Physiology and Health Sciences Center, Purdue University Northwest, Hammond, Indiana, United States
| | - Ricardo J. Fernandes
- Centre of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, Porto, Portugal
| | - Gonçalo Silva
- Centre of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, Porto, Portugal
| | - Mário J. Costa
- Centre of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, Porto, Portugal
| |
Collapse
|
13
|
Guduguntla V, Yaser JM, Keteyian SJ, Pagani FD, Likosky DS, Sukul D, Thompson MP. Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care. Circ Cardiovasc Qual Outcomes 2022; 15:e009175. [PMID: 35559710 PMCID: PMC10068673 DOI: 10.1161/circoutcomes.122.009175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite reported benefit in the setting of aortic valve replacement (AVR), cardiac rehabilitation (CR) utilization remains low, with few studies evaluating hospital and patient-level variation in CR participation. We explored determinants of CR variability during AVR episodes of care: transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS A cohort of 10 124 AVR episodes of care (TAVR n=5121 from 24 hospitals; SAVR n=5003 from 32 hospitals) were identified from the Michigan Value Collaborative statewide multipayer registry (2015-2019). CR enrollment was defined as the presence of a single professional or facility claim within 90 days of discharge: 93 797, 93 798, G0422, G0423. Annual trends and hospital variation in CR were described for TAVR, SAVR, and all AVR. Multilevel logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment. RESULTS Overall, 4027 (39.8%) patients enrolled in CR, with significant differences by treatment strategy: SAVR=50.9%, TAVR=28.9% (P<0.001). CR use after SAVR was significantly higher than after TAVR and increased over time for both modalities (P<0.001). There were significant differences in CR enrollment across age, gender, payer, and some comorbidities (P<0.05). At the hospital level, CR participation rates for all AVR varied 10-fold (4.8% to 68.7%) and were moderately correlated between SAVR and TAVR (Pearson r=0.56, P<0.01). CONCLUSIONS Substantial variation exists in CR participation during AVR episodes of care across hospitals. However, within-hospital CR participation rates were significantly correlated across treatment strategies. These findings suggest that CR participation is the product of hospital-specific practice patterns. Identifying hospital practices associated with higher CR participation can help assist future quality improvement efforts to increase CR use after AVR.
Collapse
Affiliation(s)
- Vinay Guduguntla
- Department of Internal Medicine, University of California, San Francisco (V.G.)
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
| | - Jessica M Yaser
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI (S.J.K.)
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (F.D.P., D.S.L., M.P.T.)
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
| | - Devraj Sukul
- Department of Internal Medicine, University of California, San Francisco (V.G.)
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor (D.S.)
| | - Michael P Thompson
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (F.D.P., D.S.L., M.P.T.)
| |
Collapse
|
14
|
Mathews L, Akhiwu O, Mukherjee M, Blumenthal RS, Matsushita K, Ndumele CE. Disparities in the Use of Cardiac Rehabilitation in African Americans. CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:31-41. [PMID: 35573267 PMCID: PMC9077032 DOI: 10.1007/s12170-022-00690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
Purpose of review Cardiac rehabilitation (CR) is a comprehensive outpatient program that reduces the risk of mortality and recurrent events and improves functional status and quality of life for patients recovering from acute cardiovascular disease (CVD) events. Among individuals with established CVD, African Americans have a higher risk of major cardiac events, which underscores the importance of CR use among African Americans. However, despite their high likelihood of adverse outcomes, CR is poorly utilized in African Americans with CVD. We review data on CR utilization among African Americans, barriers to participation, and the implications for policy and practice. Recent findings Although established as a highly effective secondary prevention strategy, CR is underutilized in general, but especially by African Americans. Notwithstanding efforts to increase CR participation among all groups, participation rates remain low for African Americans and other minorities compared to Non-Hispanic Whites. The low CR participation rates by African Americans can be attributed to an array of factors including differential referral patterns, access to care, and socioeconomic factors. There are several promising strategies to improve CR participation which include promoting evidence-based guidelines, reducing barriers to access, novel CR delivery modalities, including more African Americans in CR clinical research, and increasing diversity in the CR workforce. Summary African Americans with CVD events are less likely to be referred to, enroll in, and complete CR than Non-Hispanic Whites. There are many factors that impact CR participation by African Americans. Initiatives at the health policy, health system, individual, and community level will be needed to reduce these disparities in CR use.
Collapse
Affiliation(s)
- Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD USA
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
| | - Ofure Akhiwu
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD USA
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD USA
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Chiadi E. Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD USA
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21218 USA
| |
Collapse
|
15
|
Artificial Intelligence (AI) and Data-Driven Rehabilitation: The next frontier in the management of cardiometabolic disorders. Arch Phys Med Rehabil 2022; 103:1693-1695. [PMID: 35489379 DOI: 10.1016/j.apmr.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
|
16
|
Depression interventions for individuals with coronary artery disease - Cost-effectiveness calculations from an Irish perspective. J Psychosom Res 2022; 155:110747. [PMID: 35124528 DOI: 10.1016/j.jpsychores.2022.110747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/21/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND A substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease. METHODS We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise. RESULTS After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness. DISCUSSION Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.
Collapse
|
17
|
Sangani D, Krupadev V, Crawford M, Deere B, Hendel R. A Quality Improvement Initiative for Increasing Cardiac Rehabilitation Referrals Using Plan-Do-Study-Act (PDSA) Methodology. Am J Med 2022; 135:512-516. [PMID: 34813738 DOI: 10.1016/j.amjmed.2021.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cardiovascular rehabilitation has been shown to improve morbidity and mortality in patients with cardiac illnesses; however, the referral rate for eligible patients at Tulane Medical Center has remained below best practice standards. METHODS This is a single-center, quality-improvement study conducted from January 2020 through December 2020, with historical controls from 2019. Using Plan-Do-Study-Act cycle methodology, interventions were designed to improve referral rates for cardiac rehabilitation-eligible patients. Interventions included a presentation about the importance of cardiac rehabilitation and the current state of referrals, weekly reminders to residents and fellows on inpatient services with eligible patients, and an admission order set that included a default order for cardiac rehabilitation. RESULTS The primary outcome was referral rate, which was measured by the total number of referrals compared with the total number of patients eligible for cardiac rehabilitation. In this quality-improvement study of 770 patients, there was a significant increase in the referral rate for cardiac rehabilitation-eligible patients. When comparing the referral rate in 2020-following institution of quality-improvement interventions-with that from 2019, there was an increase from 27% to 70%. CONCLUSIONS This quality-improvement study found that various interventions significantly increased the cardiac rehabilitation referral rate through a straightforward and simple strategy. Further efforts are underway to promote additional referral in order to meet or exceed the >90% best practice standard.
Collapse
Affiliation(s)
- Deep Sangani
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Vinay Krupadev
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Michael Crawford
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Brad Deere
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Robert Hendel
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La.
| |
Collapse
|
18
|
Mone P, Izzo R, Marazzi G, Manzi MV, Gallo P, Campolongo G, Cacciotti L, Tartaglia D, Caminiti G, Varzideh F, Santulli G, Trimarco V. L-Arginine Enhances the Effects of Cardiac Rehabilitation on Physical Performance: New Insights for Managing Cardiovascular Patients During the COVID-19 Pandemic. J Pharmacol Exp Ther 2022; 381:197-203. [PMID: 35339987 DOI: 10.1124/jpet.122.001149] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac rehabilitation (CR) following acute myocardial infarction (AMI) improves physical capacities and decreases hospitalizations and cardiovascular mortality. L-Arginine is the substrate used by nitric oxide (NO) synthase (NOS) to generate NO and it has been shown to exert its beneficial effects on endothelium driving vasodilatation, reducing inflammation, and ameliorating physical function. We hypothesized that L-Arginine could enhance physical capacities in patients who underwent CR after AMI. We designed a study aimed to assess the effects of L-arginine administration on the physical capacity of patients who underwent coronary revascularization after AMI. The trial was carried out amid the COVID-19 pandemic. Patients were assigned, with a 2:1 ratio, to add to their standard therapy 1 bottle containing 1.66 g of L-arginine or 1 bottle of identical aspect apart from not containing L-arginine, twice a day orally for 3 weeks. Patients performed a 6-minute walking test (6MWT) and were assessed their Borg modified 0-10 rating of perceived exertion (BRPE) before starting and at the end of the treatment. Seventy-five patients receiving L-Arginine, and thirty-five receiving placebo successfully completed the study. The 6MWT distance increased significantly in the L-Arginine group compared to both baseline and placebo (p<0.0001). Additionally, we observed a significant improvement in the BRPE in patients treated with L-arginine but not in the placebo group. Taken together, our data indicate that L-arginine potentiates the response to CR, independently of age, sex, baseline functional capacity, and comorbid conditions. Significance Statement This study shows for the first time that oral supplementation of L-arginine potentiates the response to cardiac rehabilitation after myocardial infarction and cardiac revascularization. Indeed, we observed a significant improvement in two fundamental parameters, namely, the 6-minute walking test and the Borg modified 0-10 rating of perceived exertion. Strikingly, the beneficial effects of L-arginine were independent from age, sex, comorbid conditions, and baseline functional capacity.
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Daw P, Withers TM, van Zanten JJCSV, Harrison A, Greaves CJ. A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure. BMC Health Serv Res 2021; 21:1267. [PMID: 34814927 PMCID: PMC8611948 DOI: 10.1186/s12913-021-07174-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences. METHODS A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources. RESULTS Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were 'the organisation of healthcare system', 'the organisation of cardiac rehabilitation programmes', 'healthcare professional' factors and 'guidelines'. The most frequent themes included 'lack of resources: time, staff, facilities and equipment' and 'professional's knowledge, awareness and attitude'. CONCLUSIONS Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research.
Collapse
Affiliation(s)
- Paulina Daw
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Thomas M. Withers
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | | | | | - Colin J. Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| |
Collapse
|
21
|
Abstract
Purpose of Review Cardiac rehabilitation (CR) referral is a Class I post-myocardial infarction (MI) recommendation from the American Heart Association and the American College of Cardiology, yet referral rates remain strikingly low, with cardiologists some of the worst under-referring offenders. This paper seeks to review the evolution of CR and its well-established benefits, as well as reasons behind the poor referral and utilization. Recent Findings CR is a secondary prevention program for cardiovascular disease (CVD) that was first initiated in the 1970s as a hospital-based exercise program after an acute MI, but then evolved into a comprehensive multi-disciplinary program for patients with a wider range of cardiovascular diseases. CR mortality and morbidity benefits have endured over decades, even as interventional and pharmacological cardiovascular therapeutics have improved and as patients have become relatively more stable. Summary Despite being an evidence-based clinical standard, referral and participation in CR are disconcertingly low. In efforts to combat poor referral rates, and improve care in the contemporary care environment, the approach to CR is evolving. Innovations include broadening CR beyond the hospital setting into remote- and hybrid-based formats, while still incorporating exercise training, risk factor reduction, and education, as well as behavioral and psychosocial support. Nonetheless, there still remain many challenges to overcome in order to increase participation of all ages, financials, races, and sexes. With new performance measures as well as an increasing number of NIH-funded studies on the horizon, there is hope that CR will become a relatively more valued and utilized component of cardiovascular preventative care.
Collapse
Affiliation(s)
- Rebecca Lolley
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Cardiovascular Institute of North Colorado, Banner Health, 1800 15th St Suite 310, Greeley, CO, 80631, USA.
| | - Daniel E Forman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA, 15213, USA
| |
Collapse
|
22
|
Association between Big Five Personality Traits and Participation in Cardiac Rehabilitation in Japanese Patients with Cardiovascular Disease: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168589. [PMID: 34444339 PMCID: PMC8392722 DOI: 10.3390/ijerph18168589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
Cardiac rehabilitation (CR) remains underutilised, despite its established clinical benefit. A personality traits assessment may help promote CR implementation, as they are determinants of health-related behaviour. This study aimed to examine the association between the Big Five personality traits and outpatient CR participation in patients with cardiovascular disease (CVD) after discharge. This retrospective cohort study included 163 patients aged <80 years, who underwent inpatient CR when hospitalised for CVD. The Big Five personality traits (conscientiousness, neuroticism, openness, extraversion, and agreeableness) of each patient were evaluated at discharge, using the Japanese version of the Ten-Item Personality Inventory. We examined the relationship of each personality trait with non-participation in outpatient CR and dropout within three months, using logistic regression analysis. Out of 61 patients who initiated the outpatient CR, 29 patients dropped out, leaving us with 32 subjects. The logistic regression analysis results showed that high conscientiousness was associated with non-participation in CR. The primary reason for this was a lack of motivation. Conversely, low conscientiousness and high openness were predictors of dropout. This study suggests that the assessment of the Big Five personality traits, especially conscientiousness and openness, can help improve health communication with patients to promote outpatient CR participation after discharge.
Collapse
|
23
|
Lee JJ, Ko JY, Lee S. An observational study substantiating the statistical significance of cardiopulmonary exercise with laboratory tests during the acute and subacute phases of center and home-based cardiac rehabilitation. Medicine (Baltimore) 2021; 100:e26861. [PMID: 34397862 PMCID: PMC8341314 DOI: 10.1097/md.0000000000026861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
Cardiac rehabilitation (CR) can improve clinical indicators in patients with cardiovascular diseases. The literature reports a 20% reduction in all-cause mortality and a 27% reduction in heart-disease mortality following CR. Although its clinical efficacy has been established, there is uncertainty whether center-based (CBCR) is more effective than home-based (HBCR) programs in acute and subacute phases. We aimed to verify significant differences in their effectiveness for the improvement of cardiopulmonary function by analyzing cardiopulmonary exercise (CPX) with laboratory tests following both CR programs.A single-center cohort study of 37 patients, recently diagnosed with underlying cardiovascular diseases, underwent CBCR(18) and HBCR(19). CBCR group performed a supervised exercise regimen at the CR center, for 1 hour, 2 to 3 days a week, for a total of 12 to18 weeks. HBCR group completed a self-monitored exercise program at home under the same guidelines as CBCR. Participants were evaluated by CPX with laboratory tests at 1- and 6-month, following the respective programs.There was no statistical significance in clinical characteristics and laboratory findings. Pre-post treatment comparison showed significant improvement in VO2/kg, minute ventilation/carbon dioxide production slope, breathing reserve, tidal volume (VT), heart rate recovery, oxygen consumption per heart rate, low-density lipoprotein (LDL), LDL/HDL ratio, total cholesterol, ejection fraction (EF) (P < .05). CBCR approach showed greater improvement with significance in VO2/kg, metabolic equivalents, and EF on between groups analysis (P < .05).The time effect of CPX test and laboratory data showed improvement in cardiopulmonary function and serum indicators for both groups. VO2/kg, metabolic equivalents, and EF were among the variables that showed significant differences between groups. In the acute and subacute phases of 1 to 6 months, the CBCR group showed a greater cardiac output improvement than the HBCR group.
Collapse
|
24
|
Ding EY, Erskine N, Stut W, McManus DD, Peterson A, Wang Z, Escobar Valle J, Albuquerque D, Alonso A, Botkin NF, Pack QR, McManus DD. MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study. JMIR Hum Factors 2021; 8:e18130. [PMID: 34255660 PMCID: PMC8299347 DOI: 10.2196/18130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/17/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. OBJECTIVE In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch-informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. METHODS We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. RESULTS Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). CONCLUSIONS This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.
Collapse
Affiliation(s)
- Eric Y Ding
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nathaniel Erskine
- Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Wim Stut
- Philips Research, Eindhoven, Netherlands
| | - David D McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Amy Peterson
- University of Massachusetts Memorial Marlborough Hospital, Marlborough, MA, United States
| | - Ziyue Wang
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Daniella Albuquerque
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Alvaro Alonso
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Naomi F Botkin
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Quinn R Pack
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David D McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|
25
|
Lynggaard V, Zwisler AD, Taylor RS, May O, Mortensen J, Nielsen CV. Short- and long-term effects of the patient education strategy-learning and coping-in cardiac rehabilitation: a randomized controlled trial (LC-REHAB). HEALTH EDUCATION RESEARCH 2021; 36:41-60. [PMID: 33755118 DOI: 10.1093/her/cyaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
The objectives were to assess the short- and long-term effect of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on health-related quality of life, patient education impact, cardiac risk factors and lifestyle. In total, 825 patients hospitalized with ischaemic heart disease or heart failure were randomized to either LC-CR or standard CR at three Danish hospitals. Teaching approach in LC-CR was situational, inductive and reflective, with experienced patients as co-educators and supplemental interviews. Teaching approach in standard CR was structured and deductive. Outcomes were assessed immediately after CR, and after 3 months (short term), and after 3 years (long term). Between-arm differences in favour of LC-CR were SF-12 'role emotional' (3.7, 95% CI: 0.6-6.8) and MDI depression score (0.9, 0.1-1.8) immediately after CR, exercise capacity (4 W, 1-9) at 3 months and SF-12 'role physical' (4.6, 0.1-9.0) (long term). Between-arm differences in favour of controls were waist circumference (-1.7 cm, -2.3 to -1.0) immediately after CR and HeiQ domain 'Constructive attitudes and approaches' (0.11, 0.04-0.18), triglycerides (-0.12 mmol/l, -0.21 to -0.02), systolic blood pressure (-3.12 mmHg, -5.66 to -0.58) at 3 months. Adding LC strategies to CR provides inconsistent short-term results but improves 'role physical' long term.
Collapse
Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital (Formerly known as Regional Hospital West Jutland), 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
| | - R S Taylor
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
- MRC/CSO Social and Public Health Sciences Unit, Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - O May
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - J Mortensen
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| |
Collapse
|
26
|
Cascino TM, Ashur C, Richardson CR, Jackson EA, McLaughlin VV. Impact of patient characteristics and perceived barriers on referral to exercise rehabilitation among patients with pulmonary hypertension in the United States. Pulm Circ 2020; 10:2045894020974926. [PMID: 33343883 PMCID: PMC7731716 DOI: 10.1177/2045894020974926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Exercise rehabilitation is underutilized in patients with pulmonary arterial hypertension despite improving exercise capacity and quality of life. We sought to understand the association between (1) patient characteristics and (2) patient-perceived barriers and referral to exercise rehabilitation. We performed a cross-sectional survey of patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension attending an International PAH meeting. Predictors of referral considered included gender, body mass index, subjective socioeconomic status, insurance type, age, and World Health Organization functional class and perceived barriers assessed using the Cardiac Rehabilitation Barriers Scale. Among 65 participants, those in the lowest subjective socioeconomic status tertile had reduced odds of referral compared to the highest tertile participants (odds ratio 0.22, 95% confidence interval: 0.05–0.98, p = 0.047). Several patient-perceived barriers were associated with reduced odds of referral. For every 1-unit increase in a reported barrier on a five-point Likert scale, odds of referral were reduced by 85% for my doctor did not feel it was necessary; 85% for prefer to take care of my health alone, not in a group; 78% many people with heart and lung problems don’t go, and they are fine; and 78% for I didn’t know about exercise therapy. The lack of perceived need subscale and overall barriers score were associated with a 92% and 77% reduced odds of referral, respectively. These data suggest the need to explore interventions to promote referral among low socioeconomic status patients and address perceived need for the therapy.
Collapse
Affiliation(s)
- Thomas M Cascino
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Carmel Ashur
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Elizabeth A Jackson
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | |
Collapse
|
27
|
Donkers SJ, Oosman S, Milosavljevic S, Musselman KE. Addressing Physical Activity Behavior in Multiple Sclerosis Management: A Qualitative Account of Health Care Providers' Current Practices and Perspectives. Int J MS Care 2020; 22:178-186. [PMID: 32863786 DOI: 10.7224/1537-2073.2019-029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Although physical activity (PA) is considered the most important nonpharmaceutical intervention for persons with multiple sclerosis (MS), less than 20% of people with MS are engaging in sufficient amounts to accrue benefits. Promotion of PA is most effective when combined with additional behavior change strategies, but this is not routinely done in clinical practice. This study aimed to increase our understanding of current practice and perspectives of health care providers (HCPs) in Canada regarding their use of interventions to address PA behavior in MS management. Investigating HCPs' perspectives on implementing PA behavior change with persons with MS will provide insight into this knowledge-to-practice gap. Methods Semistructured focus groups were conducted with 31 HCPs working with persons with MS in Saskatchewan, Canada. Based on interpretive description, data were coded individually by three researchers, who then collaboratively developed themes. Analysis was inductive and iterative; triangulation and member reflections were used. Results Five themes were established: 1) prescribing, promoting, and impacting wellness with PA; 2) coordinating communication and continuity in practice; 3) timely access to relevant care: being proactive rather than reactive; 4) enhancing programming and community-based resources; and 5) reconciling the value of PA with clinical practice. Conclusions The HCPs value PA and want more support with application of behavior change strategies to deliver PA behavioral interventions, but due to the acute and reactive nature of health care systems they feel this cannot be prioritized in practice. Individual- and system-level changes are needed to support consistent and effective use of PA behavioral interventions in MS.
Collapse
|
28
|
Ghanbari-Firoozabadi M, Mirzaei M, Vafaii Nasab M, Grace SL, Okati-Aliabad H, Madadizadeh F, Dadras H, Amrolahi N, Entezari M, Sadrbafghi SM. Cross-cultural adaptation and psychometric validation of the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P). BMJ Open 2020; 10:e034552. [PMID: 32565454 PMCID: PMC7311040 DOI: 10.1136/bmjopen-2019-034552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study aimed to translate, cross-culturally adapt and psychometrically validate a Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P) and to identify the main barriers in an Iranian setting. SETTING Afshar cardiac rehabilitation (CR) centre, affiliated with the Yazd University of Medical Sciences, in the centre of Iran. DESIGN This was a multimethod study, culminating in a cross-sectional survey. PARTICIPANTS Inpatient CR graduates who did not attend their initial outpatient CR appointment. METHOD The 21-item CRBS was translated and cross-culturally adapted in accordance with best practices; an expert panel considered the items and previous non-attending patients were interviewed via phone to refine the scale. Next, structural validity was assessed; participants were invited to complete the CRBS on the phone between March 2017 and February 2018. Using exploratory factor analysis (EFA) with principal component analysis extraction and oblique rotation. Second, confirmatory factor analysis (CFA) was used to verify the results; several goodness-of-fit indices were considered. The internal consistency and 3-week test-retest reliability of the scale (5% subsample) were evaluated using Cronbach's α and intraclass correlation (ICC), respectively. RESULTS Face, content and cross-cultural validity were established by the experts and patients (n=50). One thousand and one hundred (40.7%) of the 2700 patients completed the CRBS-P. Structural validity was established by EFA (Bartlett's test p<0.001; =0.759) and confirmed by the CFA; a four-factor solution with 18 items accounting for 61.256% of variance had the best fit (χ2/df=3.206, root mean square error of approximation=0.061 and Comparative Fit Index=0.959). The internal consistency and test-retest reliability (n=42) of the scale were acceptable (ICC=0.743 95% CI (0.502 to 0.868); overall α=0.797). The top barriers were not knowing about CR, cost and lack of encouragement from physicians. CONCLUSION The four-factor, 18-item CRBS-P had good psychometric properties, and hence can be reliably and validly used to measure CR barriers in Iran and other Persian-speaking populations.
Collapse
Affiliation(s)
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farzan Madadizadeh
- Research Center of Prevention and Epidemiology of Non-Communicable Disease, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hakimeh Dadras
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Najmeh Amrolahi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohamadmehdi Entezari
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | |
Collapse
|
29
|
Abreu A, Frederix I, Dendale P, Janssen A, Doherty P, Piepoli MF, Völler H, Davos CH. Standardization and quality improvement of secondary prevention through cardiovascular rehabilitation programmes in Europe: The avenue towards EAPC accreditation programme: A position statement of the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2020; 28:496-509. [PMID: 33611459 DOI: 10.1177/2047487320924912] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/21/2019] [Indexed: 12/17/2022]
Abstract
Despite the proven efficacy and cost-effectiveness of contemporary cardiovascular rehabilitation programmes, the referral to/uptake of and adherence to cardiovascular rehabilitation remains inadequate. In addition, heterogeneity persists amongst different cardiovascular rehabilitation centres in Europe, despite the available scientific documents describing the evidence-based rehabilitation format/content. This position statement was elaborated by the Secondary Prevention and Rehabilitation (SP/CR) section of EAPC. It defines the minimal and optimal cardiovascular rehabilitation standards. In addition, it describes the relevant quality indicators of cardiovascular rehabilitation programmes to date. Compliance of European cardiovascular rehabilitation centres with these standards will improve cardiovascular rehabilitation process standardization in Europe and hence increase the quality of cadiovascular rehabilitation programmes.
Collapse
Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Portugal.,Centro Académico de Medicina de Lisboa (CAML), Universidade de Lisboa, Portugal.,Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL)
| | - Ines Frederix
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL).,Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,Department of Cardiology, Jessa Hospital, Belgium.,Faculty of Medicine & Health Sciences, Antwerp University, Belgium
| | - Paul Dendale
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL).,Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Arne Janssen
- Faculty of Medicine & Health Sciences, Antwerp University, Belgium
| | | | - Massimo F Piepoli
- Department of Health Sciences, University of York, UK.,Heart Failure Unit, G da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Heinz Völler
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy.,Department of Cardiology, Klinik am See, Germany
| | -
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Germany
| | - Constantinos H Davos
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Italy
| |
Collapse
|
30
|
Forsyth F, Deaton C. Women and cardiac rehabilitation: Moving beyond barriers to solutions? Eur J Prev Cardiol 2020; 28:758-760. [PMID: 33611477 DOI: 10.1177/2047487320911843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Faye Forsyth
- University of Cambridge School of Clinical Medicine, Department of Public Health and Primary Care, UK
| | - Christi Deaton
- University of Cambridge School of Clinical Medicine, Department of Public Health and Primary Care, UK.,Cambridge University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
31
|
Winnige P, Batalik L, Filakova K, Hnatiak J, Dosbaba F, Grace SL. Translation and validation of the cardiac rehabilitation barriers scale in the Czech Republic (CRBS-CZE): Protocol to determine the key barriers in East-Central Europe. Medicine (Baltimore) 2020; 99:e19546. [PMID: 32176110 PMCID: PMC7440137 DOI: 10.1097/md.0000000000019546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are highly prevalent and represent leading causes of morbidity worldwide, including in Central Europe. Cardiac rehabilitation (CR) is an effective method of secondary prevention, but utilization is low. Barriers to CR use in the Czech Republic are not well-characterized, and therefore we propose a protocol to translate and validate the cardiac rehabilitation barriers scale (CRBS). METHODS In this multi-method study, we translated and cross-culturally validated the CRBS to Czech (CRBS-CZE) first through the following main steps: professional translation, reconciliation/harmonization, and cross-cultural adaptation, and piloting in 50 cardiac patients. A prospective study will be undertaken to psychometrically-validate the CRBS-CZE, where 300 to 600 cardiac inpatients eligible for phase II/outpatient CR will be recruited. Consenting participants will be informed about the CR program and their sociodemographic, clinical characteristics, and the CRBS-CZE administered. Factor analysis will be performed with oblique rotation, factors will be extracted based on eigenvalues, the examination of the scree plot, and factor loadings. The internal reliability of the total scale and subscales will be assessed with Cronbach alpha. Overall CRBS scores will be compared by patient characteristics such as sex, socioeconomic indicators, risk factor burden, and travel time to investigate content validity. Their CR enrollment, adherence (% of 24 prescribed sessions attended), and completion will be tracked. The second administration of CRBS-CZE will be undertaken in patients at 3 weeks after enrollment. To test criterion validity, t tests and Pearson correlation (for adherence) will be used to determine the association of these utilization indicators with CRBS scores. RESULTS The translated version was considered by 2 bilingual CR experts. Some revisions and example additions were made to the items. Upon piloting with patients, some further edits were made. No additional barriers were raised. DISCUSSION Through this study, a reliable and valid means of assessing patient's CR barriers will be established. Results will be used to identify ways to help patients overcome barriers to CR utilization.
Collapse
Affiliation(s)
- Petr Winnige
- Department of Rehabilitation, University Hospital Brno
- Department of Public Health, Faculty of Medicine, Masaryk University Brno
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno
- Department of Internal Cardiology Medicine, University Hospital Brno, Brno, Czech Republic
| | | | - Jakub Hnatiak
- Department of Rehabilitation, University Hospital Brno
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno
| | - Sherry L. Grace
- Faculty of Health, York University & University Health Network, University of Toronto, Toronto, Canada
| |
Collapse
|
32
|
Chaves G, Turk-Adawi K, Supervia M, Santiago de Araújo Pio C, Abu-Jeish AH, Mamataz T, Tarima S, Lopez Jimenez F, Grace SL. Cardiac Rehabilitation Dose Around the World: Variation and Correlates. Circ Cardiovasc Qual Outcomes 2020; 13:e005453. [PMID: 31918580 DOI: 10.1161/circoutcomes.119.005453] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended in clinical practice guidelines, but dose prescribed varies highly by country. This study characterized the dose offered in supervised CR programs and alternative models worldwide and their potential correlates. METHODS AND RESULTS In this cross-sectional study, an online survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Countries were classified based on region and income categories. Dose was operationalized as program duration×sessions per week. Generalized linear mixed models were performed to assess correlates. Of 203 countries in the world, 111 (54.7%) offered CR; data were collected in 93 (83.8% country response rate; n=1082 surveys, 32.1% program response rate). Globally, supervised CR programs were a median of 24 sessions (n=619, 57.3% programs ≥12 sessions); home-based and community-based programs offered 6 and 20 sessions, respectively. There was significant variation in supervised CR dose by region (P≤0.001), with the Americas (median, 36 sessions) offering a significantly greater dose than several other regions; there was also a trend for variation by country income classification. There was no difference in home-based dose by region (P=0.43) but there was for community-based programs (P<0.05; Americas offering greater dose). There was a significant dose variation in both home- and community-based programs by income classification (P=0.002 and P<0.001, respectively), with higher doses offered by upper-middle-income than high-income countries. Correlates of supervised CR dose included more involvement of physicians (P=0.026), proximity to other programs (P=0.002), and accepting patients with noncardiac indications (P=0.037). CONCLUSIONS CR programs in many countries may need to increase their dose, which could be supported through physician champions.
Collapse
Affiliation(s)
- Gabriela Chaves
- Faculty of Health, York University, Toronto, ON, Canada (G.C., C.S.d.A.P., T.M., S.L.G.)
| | | | - Marta Supervia
- Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain (M.S.).,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.S., F.L.J.)
| | | | - Abdel-Hadi Abu-Jeish
- Surgical Department, Hamad General Hospitals, Hamad Medical Corporation, Doha, Qatar (A.-h.A.-J.)
| | - Taslima Mamataz
- Faculty of Health, York University, Toronto, ON, Canada (G.C., C.S.d.A.P., T.M., S.L.G.)
| | - Sergey Tarima
- Department of Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee (S.T.)
| | | | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada (G.C., C.S.d.A.P., T.M., S.L.G.).,Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, ON, Canada (S.L.G.)
| |
Collapse
|
33
|
Santiago de Araújo Pio C, Chaves G, Davies P, Taylor R, Grace SL. Cochrane corner: increasing patient utilisation of cardiac rehabilitation. Heart 2019; 106:248-250. [PMID: 31427366 DOI: 10.1136/heartjnl-2019-315348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Gabriela Chaves
- Rehabilitation Science Program, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Philippa Davies
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rod Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK.,Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada .,KITE-Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|