Obstacles and alternative options for cardiac rehabilitation in Nanjing, China: an exploratory study

Abstract

BackgroundCoronary heart disease (CHD) is a major cause of morbidity and mortality, and cardiac rehabilitation (CR) is still not well developed in mainland China. The objective of this study is to investigate the barriers associated with those seeking cardiac rehabilitation (CR) and to explore appropriate secondary prevention modalities tailored to the needs of Chinese patients with coronary heart disease (CHD).MethodsA consecutive series of eligible patients was recruited from the cardiac department of a teaching hospital in Nanjing, located in southeast China. Structured face-to-face interviews were conducted with 328 patients prior to hospital discharge. Patient preferences for seeking an outpatient CR program or an alternative outpatient self-choice, minimal-cost educational program were evaluated. Socio-demographic characteristics and clinical data were assessed. Additionally, patients were asked to provide the reasons affecting their choice.ResultsOverall, only 14.3% patients preferred the standard CR program. Factors associated with non-participating were female gender (odds ratios [ORs], 6.05, 95% CI, 1.30-28.19), older age (ORs, 1.11, 95% CI, 1.04-1.19, per year), less education (ORs, 8.13, 95% CI, 2.83-23.38), low income (ORs, 3.26, 95% CI, 1.24-8.54), and having either basic medical care or a lack of health insurance (ORs, 10.01, 95% CI, 3.90-25.68). The most common reason for refusing to participate in CR was that patients could not afford it. Of the remaining patients, 65.8% patients chose self-choice educational programs, especially for female (ORs, 5.84, 95% CI, 2.67-12.79), older (ORs, 1.06, 95% CI, 1.02-1.11, per year), and low income (ORs, 2.14, 95% CI, 1.12-4.10) patients. The main reasons for their preferences were their desires for more information about disease and risk factors, the low cost, feasibility, and saving time.ConclusionsMultiple barriers, which may occur at the patient, health system, and societal levels, have prevented eligible patients from participating in CR programs. Self-choice educational programs, an alternative model incorporating more information, would strongly meet the needs of most patients. A feasible delivery format for secondary prevention should be provided for all CHD patients.

Impacts of intensive follow-up on the long-term prognosis of percutaneous coronary intervention in acute coronary syndrome patients – a single center prospective randomized controlled study in a Chinese population

“…Frequent contact through telephone calls (five times during the first year) and necessary face-to-face appointments facilitated the communications between cardiologists and patients. Given that cardiac secondary prevention programs were rarely offered to Chinese patients, 13,14 participating patients were likely to be motivated and follow the suggestions made by cardiologists. Other factors, such as the younger age (61 years on average), fewer of female gender (23%) and the initial exclusion of patients who were not able or willing to accomplish follow-ups, may also result in good compliances.…”

“…8,10,12 However, various factors at the patient, health system or societal level have prevented eligible patients from participating in secondary prevention programs in China and this is closely associated with the low medication adherence. 13–16 Cardiovascular secondary prevention programs beyond the existing nurse-coordinated programs are therefore needed for Chinese patients, and their impacts on the long-term disease prognosis of patients after percutaneous coronary intervention (PCI) remain to be investigated.…”

A qualitative study on barriers to practitioner implementation of cardiac rehabilitation services in a tertiary health facility in Kano, Nigeria

“…Most of the previous qualitative studies were conducted in advanced countries where cardiac rehabilitation was available and so investigation focused on the reasons for its underutilization such as patient lack of enrolment in the programme for fear of partaking in physical exercise, and logistical challenges (transportation, distance) as well as high cost of cardiac rehabilitation (De Vos et al, 2012;Jin et al, 2014;Sérvio et al, 2019). Until we have functional comprehensive cardiac rehabilitation programmes, it will be impossible for us to categorically state that such factors as exercise phobia, knowledge, and income militate against the implementation of cardiac rehabilitation.…”

Establishing a process to translate and adapt health education materials for natives and immigrants: The case of Mandarin adaptations of cardiac rehabilitation education

“…4,5 The burden of CVD in Chinese immigrants is also then important to address, 6,7 particularly given their higher mortality after hospitalization. 8 Secondary prevention strategiesparticularly where they are culturally-relevant and hence readily implementable by patients [9][10][11][12] can mitigate this burden.…”

“…28 While it is not feasible to offer this in all CR programs as they would not have available staff with all needed language skills, having online resources available could bridge this gap, particularly considering self-directed educational programs are preferred by most Chinese cardiac patients. 29 Cardiac College TM is the only standardized, comprehensive, evidence-based, online, multi-media patient education intervention freely-available worldwide to our knowledge. It was developed through a rigorous process, informed by adult learning principles 30 and the Health Action Process Approach (HAPA), 31 in partnership with patients and global CR experts.…”