Cardiac rehabilitation services in Ontario

Polyzotis, Peter A.; Tan, Yongyao; Prior, Peter; Oh, Paul; Fair, Terry; Grace, Sherry L.

doi:10.2459/jcm.0b013e32835794c1

Cited by 25 publications

(12 citation statements)

References 24 publications

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“…Major barriers (again reported on the same 5-point scale as per above) also included patient referral (3.2), and lack of equipment (2.7). In the provincial survey 76 , results showed that in addition to those shown in Table 1, 68% of programs also offered psychosocial services. There were also 2 narrative reviews published describing CR status in Canada 42,77 .…”

Section: Cr Delivery In North Americamentioning

confidence: 90%

A Review of Cardiac Rehabilitation Delivery Around the World

Pesah

Supervía

Turk-Adawi

et al. 2017

Progress in Cardiovascular Diseases

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Herein, 28 publications describing cardiac rehabilitation (CR) delivery in 50 of the 113 countries globally suspected to deliver it are reviewed, to characterize the nature of services. Government funding was the main source of CR reimbursement in most countries (73%), with private and patient funding in about ¼ of cases.Myocardial infarction patients and those having revascularization were commonly served. The main professions delivering CR were physicians, nurses, and physiotherapists. Programs offered a median of 20 sessions, although this varied. Most programs offered the core components of exercise training, patient education and nutrition counselling. Alternative models were not commonly offered. Lack of human and/or financial resources as well as space constraints were reported as the major barriers to delivery. Overall, CR delivery has been characterized in less than half of the countries where it is offered. The nature of services delivered is fairly consistent with major CR guidelines and statements.Keywords: cardiac rehabilitation, global health, secondary prevention Alphabetical List of Abbreviations: AS= administrative support CABG = coronary artery bypass graft CB = community-based A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT2 CR = cardiac rehabilitation CPR= cardiopulmonary resuscitation CVD = cardiovascular disease ECG = electrocardiogram EQ= equipment ET = exercise training FR= financial resources HB = home-based HF = heart failure HR= human resources IA = initial assessment IB = internet-based IHD = ischemic heart disease LMIC = low-and middle-income country MI = myocardial infarction NC = nutrition counseling NZ = New Zealand PAW= patient awareness PCI = percutaneous coronary intervention PE = patient education PR= patient referral RF = risk factor management SC = smoking cessation SM = stress management and/or psychosocial support/counselling TI = transportation issues UAE = United Arab Emirates VAD = ventricular assist device A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 By 2030, it is expected 84 million individuals will be diagnosed with cardiovascular disease (CVD) 1 .Moreover, it is among the leading causes of disability around the world, and contributes to 10% of disabilityadjusted life years lost world-wide 2 . With improved survival (in high-income countries 3 ), clearly there is a great need for secondary prevention, such as is offered in cardiac rehabilitation (CR) programs.Many meta-analyses demonstrate that participation in CR is associated with improved quality of life, as well as decreased morbidity and mortality [4][5][6][7] . CR is also cost-effective 8 . Accordingly, it is a class 1 level A recommendation in clinical practice guidelines for CVD patients 9,10 . 19 , have established guidelines to ensure consistent provision and quality of CR delivery in order to achieve the greatest population health benefits. They all outline the nature of patients indicated for services, and make recommendations regarding the composition of a multi-disciplinary...

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Section: Cr Delivery In North Americamentioning

confidence: 90%

A Review of Cardiac Rehabilitation Delivery Around the World

Pesah

Supervía

Turk-Adawi

et al. 2017

Progress in Cardiovascular Diseases

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“…In general, patients attend CR twice per week for over 4–6 months,8 during which time they receive the well-established core components of the model, namely risk factor assessment, structured exercise training, patient education, as well as dietary and psychosocial counseling 9. CR participation is associated with 20% lower cardiovascular mortality,10 with greater participation associated with greater benefits 11.…”

Section: Introductionmentioning

confidence: 99%

Patient satisfaction with cardiac rehabilitation: association with utilization, functional capacity, and heart-health behaviors

Ali

Chessex

Bassett‐Gunter

et al. 2017

PPA

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BackgroundCardiac rehabilitation (CR) societies recommend assessment of patient satisfaction given its association with health care utilization and outcomes. Recently, the Patient Assessment of Chronic Illness Care (PACIC, Glasgow) was recommended as an appropriate tool for the CR setting. The objectives of this study were to 1) describe patient satisfaction with CR, 2) test the psychometric properties of the PACIC in the CR setting, and 3) assess the association of patient satisfaction with CR utilization and outcomes.MethodsSecondary analysis was conducted on an observational, prospective CR program evaluation cohort. A convenience sample of patients from 1 of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey. Clinical data were extracted from charts pre- and post-program. Participants were e-mailed surveys again 6 months (including the PACIC) and 1 and 2 years later.ResultsOf 411 consenting patients, 247 (60.2%) completed CR. The mean PACIC score was 2.8±1.1/5. Internal reliability was α=0.95. The total PACIC score varied significantly by site (F=3.12, P=0.046), indicating discriminant validity. Patient satisfaction was significantly related to greater CR adherence (r=0.22, P<0.01) and completion (t=2.63, P<0.01), greater functional status at CR discharge (r=0.17, P=0.03) and 2 years post-intake (r=0.19, P=0.03), greater physical activity at discharge (r=0.18, P=0.02), as well as lower depressive symptoms at discharge (r=−0.16, P=0.02) and 1-year follow-up (r=−0.19, P=0.03). These associations sustained adjustment for sex.ConclusionPatients were relatively satisfied with their care. The PACIC is a psychometrically validated scale, which could serve as a useful tool to assess patient satisfaction with CR.

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“…CR services are covered through provincial health insurance in these jurisdictions. CR programming is guided by the Canadian Association of Cardiac Rehabilitation guidelines [20], averaging five months in duration, with a median of two supervised sessions per week [21]. Overall there were 17 cardiac wards at these hospitals, as one hospital had three cardiac wards, and four hospitals had two cardiac wards each ( i.e.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study

et al. 2012

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BackgroundDespite the evidence of benefit, cardiac rehabilitation (CR) remains highly underutilized. The present study examined the effect of two inpatient and one outpatient strategy on CR utilization: allied healthcare provider completion of referral (a policy that had been endorsed and approved by the cardiac program leadership in advance; PRE-APPROVED); CR intake appointment booked before hospital discharge (PRE-BOOKED); and early outpatient education provided at the CR program shortly after inpatient discharge (EARLY ED).In this prospective observational study, 2,635 stable cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey, and clinical data were extracted from charts. One year later, participants were a mailed survey that assessed CR use. Participating inpatient units and CR programs to which patients were referred were coded to reflect whether each of the strategies was used (yes/no). The effect of each strategy on participants’ CR referral and enrollment was examined using generalized estimating equations.ResultsA total of 1,809 participants completed the post-test survey. Adjusted analyses revealed that the implementation of one of the inpatient strategies was significantly related to greater referral and enrollment (PRE-APPROVED: OR = 1.96, 95%CI = 1.26 to 3.05, and OR = 2.91, 95%CI = 2.20 to 3.85, respectively). EARLY ED also resulted in significantly greater enrollment (OR = 4.85, 95%CI = 2.96 to 7.95).ConclusionsThese readily-implementable strategies could significantly increase access to and enrollment in CR for the cardiac population. The impact of these strategies on wait times warrants exploration.

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Cardiac rehabilitation services in Ontario

Cited by 25 publications

References 24 publications

A Review of Cardiac Rehabilitation Delivery Around the World

A Review of Cardiac Rehabilitation Delivery Around the World

Patient satisfaction with cardiac rehabilitation: association with utilization, functional capacity, and heart-health behaviors

Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study

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