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Alexandre A, Campinas A, Schmidt C, Magalhaes S, Preza-Fernandes J, Silveira J, Gomes C, Santos M, Torres S. Clinical determinants and barriers to cardiac rehabilitation enrolment of patients with heart failure with reduced ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cardiac rehabilitation (CR) is a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF). Despite the robust evidence supporting its safety and benefits, there is an incomplete understanding of the reasons of the underutilization of CR programs in HFrEF. These reasons are complex and probably encompass healthcare system- and patient-level barriers.
Purpose
To study the clinical determinants and barriers to enrolment in a CR program for HFrEF patients.
Methods
We conducted a study of consecutive heart failure patients followed at a dedicated HFrEF cardiology clinic from January 2019 to April 2021. Patients were divided according to previous enrolment in CR program. Data were collected from electronic health records, and in case of missing data patients were asked by telephone about the reason for not participating in CR using a structured and validated questionnaire for this purpose.
Results
Of 228 patients with HFrEF, 60% had not been enrolled in a CR program; they were older (63 vs 58 years; p<0.01) and more likely to have comorbidities such as hypertension (56% vs 41%; p=0.03) or concomitant chronic obstructive pulmonary disease (20% vs 8%; p=0.01). Conversely, patients enrolled in CR programs were more likely to have a previous history of acute myocardial infarction (34% vs 20%; p=0.02). Regarding heart failure-related clinical features (NYHA functional class, LVEF, ICD/CRT), we did not find any significant differences between groups. The main reasons for not being enrolled in CR programs were: no medical referral (31%), concomitant medical problems (27%) such as musculoskeletal problems, patient refusal (11%) and geographical distance to the hospital (9%).
Conclusion
Despite the high proportion (40%) of HFrEF patients who underwent CR program compared to previous studies, the enrolment to CR can be further improved. The main barriers are related to health professionals (no referral), healthcare system (geographical distance to the hospital) and patients (concomitant noncardiac problems). Innovative strategies should target these factors to increase the delivery of CR program in HFrEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Alexandre
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - A Campinas
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - C Schmidt
- Faculty of Medicine University of Porto, Department of Surgery and Physiology , Porto , Portugal
| | - S Magalhaes
- Hospital University Center of Porto , Porto , Portugal
| | | | - J Silveira
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - C Gomes
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - M Santos
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - S Torres
- Hospital University Center of Porto, Cardiology , Porto , Portugal
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Silveira I, Sousa M, Brochado B, Barreira A, Magalhaes S, Viamonte S, Preza-Fernandes J, Luz A, Torres S. P4906Impact of cardiac rehabilitation in obese patients with coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rodrigues P, Santos M, Anjo D, Sousa MJ, Brochado B, Barreira A, Viamonte S, Preza-Fernandes J, Palma P, Torres S. Cardiac rehabilitation: improving the prognosis of ischemic heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rodrigues P, Santos M, Sousa MJ, Anjo D, Brochado B, Barreira A, Viamonte S, Preza-Fernandes J, Palma P, Torres S. Cardiac rehabilitation: does age matter? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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