Cardiac rehabilitation after acute coronary syndrome comparing adherence and risk factor modification in a community-based shared care model versus hospital-based care in a randomised controlled trial with 12 months of follow-up

Bertelsen, Jannik Buus; Refsgaard, Jens; Kanstrup, Helle; Johnsen, Søren P; Qvist, Ina; Christensen, Bo; Christensen, Kent Lodberg

doi:10.1177/1474515116666781

Cited by 10 publications

(12 citation statements)

References 16 publications

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“…Details regarding excluded and ongoing trials, as well as those awaiting classification, are reported elsewhere [46]. Ultimately, 14 new trials met the inclusion criteria [47,48,49,50,51,52,53,54,55,56,57,58,59,60,61]. Thus, 26 trials (5299 participants) have been included in this update; the details of each trial are shown elsewhere [46].…”

Section: Resultsmentioning

confidence: 99%

“…Eleven trials (2323 participants) evaluating interventions to increase adherence to CR were included. [34,35,41,48,49,50,51,52,53,54,61,62] Of these RCTs, in 8 (72.7%) the outcome was quantified in a manner comparable with the definition used herein (exceptions were Bertelsen et al [48], McGrady et al [61], and Pack et al [41]). Finally, the outcome of completion was examined for the first time in this review.…”

Section: Resultsmentioning

confidence: 99%

“…Trials may have reported adverse events (or lack thereof) associated with CR participation. Two RCTs included herein incorporated an economic analysis [48,53]. One trial examined the role of home-based CR in increasing adherence, and the other assessed the cost-utility of offering CR in primary care and in the community versus in the hospital.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to Promote Patient Utilization of Cardiac Rehabilitation: Cochrane Systematic Review and Meta-Analysis

Pio

Chaves

Davies

et al. 2019

JCM

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Too few patients utilize cardiac rehabilitation (CR), despite its benefits. The Cochrane review assessing the effectiveness of interventions to increase CR utilization (enrolment, adherence, and completion) was updated. A search was performed through July 2018 of the Cochrane and MEDLINE (Medical Literature Analysis and Retrieval System Online) databases, among other sources. Randomized controlled trials in adults with myocardial infarction, angina, revascularization, or heart failure were included. Interventions had to aim to increase utilization of comprehensive phase II CR. Two authors independently performed all stages of citation processing. Following the random-effects meta-analysis, meta-regression was undertaken to explore the impact of pre-specified factors. Twenty-six trials with 5299 participants were included (35.8% women). Low-quality evidence showed an effect of interventions in increasing enrolment (risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.13–1.42). Meta-regression analyses suggested that the intervention deliverer (nurse or allied healthcare provider, p = 0.02) and delivery format (face-to-face, p = 0.01) were influential in increasing enrolment. There was low-quality evidence that interventions to increase adherence were effective (standardized mean difference (SMD) = 0.38, 95% CI = 0.20–0.55), particularly where remotely-offered (SMD = 0.56, 95% CI = 0.36–0.76). There was moderate-quality evidence that interventions to increase program completion were effective (RR = 1.13, 95% CI = 1.02–1.25). There are effective interventions to increase CR utilization, but more research is needed to establish specific, implementable materials and protocols, particularly for completion.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interventions to Promote Patient Utilization of Cardiac Rehabilitation: Cochrane Systematic Review and Meta-Analysis

Pio

Chaves

Davies

et al. 2019

JCM

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“…medications, lifestyle, and risk factor control recommendations) [37] and leads to improvements in left ventricular ejection fraction, exercise tolerance, and cardiovascular risk factors [38]. When compared with hospital-based cardiac rehabilitation in a randomized trial, shared-care rehabilitation involving healthcare centers and primary care providers demonstrated similar effects on medication adherence and cardiovascular risk factors [39], as well as similar total healthcare-associated costs [40].…”

Section: Cardiac Rehabilitationmentioning

confidence: 99%

Transition of care to prevent recurrence after acute coronary syndrome: the critical role of the primary care provider and pharmacist

Goldman

Harte²

2020

Postgraduate Medicine

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Despite therapeutic advances, patients with acute coronary syndrome (ACS) are at an increased longterm risk of recurrent cardiovascular events. This risk continues to rise as the number of associated comorbidities, often observed in patients presenting with ACS, increases. Such a level of clinical complexity can lead to gaps in care and subsequently worse outcomes. Guidelines recommend providing an evidence-based post-discharge plan to prevent readmission and recurrent ACS, including cardiac rehabilitation, medication, patient/caregiver education, and ongoing follow-up. A patientcentric multidisciplinary approach is critical for the effective management of the transition of care from acute care in the hospital setting to the outpatient care setting in patients with ACS. Ongoing communication between in-hospital and outpatient healthcare providers ensures that the transition is smooth. Primary care providers and pharmacists have a pivotal role to play in the effective management of transitions of care in patients with ACS. Guideline recommendations regarding the postdischarge care of patients with ACS and the role of the primary care provider and the pharmacist in the management of transitions of care will be reviewed. ARTICLE HISTORY

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“…Furthermore, community healthcare services can play a vital role in patient rehabilitation post myocardial infarction, something with a convincing evidence base for improved outcomes. 14 Community based rehabilitation has been shown to have comparable outcomes to similar hospital based services 15 , so there is potentially scope to reduce demand on hospitals by shifting these services out to the community. Although rehabilitation services do exist at SGNHC 11 , the fact that they are hospital based means that is very difficult to reach the wider populations of Nepal.…”

Section: Journey Into Hospitalmentioning

confidence: 99%

How do the cardiology services for patients presenting with acute coronary syndromes compare between developing and developed countries?

Mears

2019

Nepalese Heart J.

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Background and Aims: Acute Coronary Syndromes (ACS) represent a significant challenge for healthcare systems worldwide, however there is a vast disparity between developed and developing countries in terms of their management and subsequent patient outcomes. The aim of this reflective report was to explore the services provided for ACS patients in the developing country Nepal and compare them to the highly developed United Kingdom. This was with a view to summarise the priorities for Nepal going forward in addressing this major public health challenge and improving their ACS patient outcomes.Methods: This reflective report was constructed following an elective placement at the Shahid Gangalal National Heart Centre in Kathmandu, Nepal. It involved collecting numerous ACS patient case studies from the United Kingdom (UK) and Nepal and reflecting on their clinical experiences using the Gibbs Reflective Cycle.Reflective Summary: The treatment strategies for ACS are very similar in both countries, however in Nepal it is more difficult to efficiently transport patients into hospital and the population is less aware of the symptoms of ACS, thus contributing to delayed presentations and poorer outcomes. Furthermore, the provision of non-emergency healthcare, collection of patient data and general hospital resources were understandably deficient in comparison to the UK given the difference in financial status.Discussion: In order to address the rising incidence of ACS, Nepal should prioritise investment in the hospital facilities provided for these patients, including suitably equipped emergency transport and cardiac catheterisation laboratories. In addition, they should work towards an electronic patient database and more established non-emergency healthcare services. Perhaps most importantly is the need for improved health promotion about the risk factors for ACS and the signs of a heart attack.

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Cardiac rehabilitation after acute coronary syndrome comparing adherence and risk factor modification in a community-based shared care model versus hospital-based care in a randomised controlled trial with 12 months of follow-up

Abstract: Adherence to phase II CR was high in both groups. SC-CR did not improve adherence and efficacy, but had comparable effects on medication and risk factors. Thus, SC-CR was safe and effective.

Cited by 10 publications

References 16 publications

Interventions to Promote Patient Utilization of Cardiac Rehabilitation: Cochrane Systematic Review and Meta-Analysis

Interventions to Promote Patient Utilization of Cardiac Rehabilitation: Cochrane Systematic Review and Meta-Analysis

Transition of care to prevent recurrence after acute coronary syndrome: the critical role of the primary care provider and pharmacist

How do the cardiology services for patients presenting with acute coronary syndromes compare between developing and developed countries?

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