Promoting patient uptake and adherence in cardiac rehabilitation

Abstract

Background-Cardiac rehabilitation is an important component of recovery from coronary events but uptake and adherence to such programmes are below the recommended levels. This aim is to update a previous non-Cochrane systematic review which examined interventions that may potentially improve cardiac patient uptake and adherence in rehabilitation or its components and concluded that there is insufficient evidence to make specific recommendations.

Narrative Review Comparing the Benefits of and Participation in Cardiac Rehabilitation in High-, Middle- and Low-Income Countries

“…The Cochrane review on interventions to increase CR participation and adherence has recently been updated [67]. There were 8 interventions demonstrated to successfully increase participation, including motivational letters, structured nurse or therapist-led contacts via phone calls or visits, early CR appointments within 10 days after hospitaldischarge, gender-specific programs, and intermediate phase programs for elderly patients.…”

“…There were 8 interventions demonstrated to successfully increase participation, including motivational letters, structured nurse or therapist-led contacts via phone calls or visits, early CR appointments within 10 days after hospitaldischarge, gender-specific programs, and intermediate phase programs for elderly patients. There were 3 adherence interventions demonstrated to successfully increase CR adherence namely daily self-monitoring of activity, action planning, and tailored counselling by CR staff [67]. While all these trials were undertaken in HICs, some of these strategies could be applicable in middle-income countries.…”

Evaluating the impact of the Eastern Academic Health Science Network Transformation Support Unit

“…Exercise-based CR, as is provided in CR + , has also been found to reduce the risk of death due to a cardiovascular cause, and economic evaluations have found the intervention to be cost-effective (Anderson et al, 2016). However, despite the favourable evidence on the effectiveness of the CR programmes, the uptake rate in the UK and Europe is below the recommended levels (Bethell et al, 2001, Karmali et al, 2014, Kotseva et al, 2009. The use of self-monitoring equipment in the CR + programme allows the provision of centre-based treatment to be continued into the patient's home.…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…563,564 Referrals to CR can be increased through electronic prompts or automatic referrals, while patient uptake may be improved with structured follow-up by nurses or therapists and early starts to programmes after discharge. 557,558,565 Nurse-led programmes can also deliver effective preventive programmes in patients with CVD. The EUROACTION trial used a 16 week family-centred approach that led to healthier lifestyle changes in activity and diet and more effective control of risk factors in patients and their partners compared with usual care.…”