Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

Pio, Carolina Santiago de Araújo; Beckie, Theresa M.; Varnfield, Marlien; Sarrafzadegan, Nizal; Babu, Abraham Samuel; Baidya, Sumana; Buckley, John; Chen, Ssu-Yuan; Gagliardi, Anna R.; Heine, Martin; Khiong, Jong Seng; Mola, Ana; Radi, Basuni; Supervía, Marta; Trani, Maria R.; Abreu, Ana; Sawdon, John A.; Moffatt, Paul D.; Grace, Sherry L.

doi:10.1016/j.ijcard.2019.06.064

Cited by 50 publications

(55 citation statements)

References 46 publications

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“…This has also been noted in the literature, with greater adherence when cardiac rehabilitation is able to be done (at least partially) in a home-based setting. 21 Home-based exercise programs should only be implemented after patients have been assessed and deemed safe to exercise at home. 25 The use of monitored tele-health service models, where physiotherapist intervention, supervision and education can be delivered remotely, may also be beneficial, and warrant further investigation.…”

Section: Enablers Of Exercisementioning

confidence: 99%

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

et al. 2020

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Objectives: To identify patterns of exercise behaviour, attitudes towards exercise, barriers and enablers of exercise for people living with Pulmonary Hypertension (PH). Accessibility of rehabilitation services from a patient perspective was also explored. Methods: a voluntary, international survey of people living with PH was conducted, with mixed quantitative and qualitative data collection, in an online and paper format. Results: Data from 187 participants in 19 countries were included in the analyses. 52% (95/183) of people with PH reported that they attempted to engage in regular physical activity. This was less than the proportion who did so prior to diagnosis (61%, 112/184, p=0.006), and was accompanied by uncertainty and anxiety about exercise. 63% (113/180) of the cohort reported experiencing previous adverse events whilst exercising, which was associated with a greater likelihood of ongoing exercise concerns and anxiety. Fear, frustration and uncertainty about exercise were noted as common barriers to engaging in exercise with PH. Other barriers to exercise included intrinsic factors such as debilitating breathlessness and fatigue, and external factors such as cost and access to appropriate services. Most respondents (76%, 128/169) did not have access to a multi-disciplinary rehabilitation service, although an overwhelming majority (92%, 159/172) reported this would be helpful. Respondents rated education; a supervised, structured exercise program; and psychology input as the most important components of a multi-disciplinary rehabilitation service for PH. Conclusion: Health professionals must work together with consumers to co-design rehabilitation services that will facilitate exercise and increased activity for people living with PH.

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Section: Enablers Of Exercisementioning

confidence: 99%

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

et al. 2020

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“…This could be undertaken most feasibly and affordably through communication at the bedside with CV inpatients prior to hospital discharge. A position statement to forward recommendations based on the findings was subsequently developed, and endorsed by 23 medical societies [15,16].…”

Section: Introductionmentioning

confidence: 99%

Implementing recommendations for inpatient healthcare provider encouragement of cardiac rehabilitation participation: development and evaluation of an online course

Pio

Gagliardi

Suskin

et al. 2020

BMC Health Serv Res

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Background: A policy statement recommending that healthcare providers (HCPs) encourage cardiac patients to enroll in cardiac rehabilitation (CR) was recently endorsed by 23 medical societies. This study describes the development and evaluation of a guideline implementation tool. Methods: A stepwise multiple-method study was conducted. Inpatient cardiac HCPs were recruited between September 2018-May 2019 from two academic hospitals in Toronto, Canada. First, HCPs were observed during discharge discussions with patients to determine needs. Results informed selection and development of the tool by the multidisciplinary planning committee, namely an online course. It was pilot-tested with target users through a think-aloud protocol with subsequent semi-structured interviews, until saturation was achieved. Results informed refinement before launching the course. Finally, to evaluate impact, HCPs were surveyed to test whether knowledge, attitudes, self-efficacy and practice changed from before watching the course, through to post-course and 1 month later. Results: Seven nurses (71.4% female) were observed. Five (62.5%) initiated dialogue about CR, which lasted on average 12 s. Patients asked questions, which HCPs could not answer. The planning committee decided to develop an online course to reach inpatient cardiac HCPs, to educate them on how to encourage patients to participate in CR at the bedside. The course was pilot-tested with 5 HCPs (60.0% nurse-practitioners). Revisions included providing evidence of CR benefits and clarification regarding pre-CR stress test screening. HCPs did not remember the key points to convey, so a downloadable handout was embedded for the point-of-care. The course was launched, with the surveys. Twenty-four HCPs (83.3% nurses) completed the pre-course survey, 21 (87.5%) post, and 9 (37.5%) 1 month later. CR knowledge increased from pre (mean = 2.71 ± 0.95/5) to post-course (mean = 4.10 ± 0.62; p ≤ .001), as did self-efficacy in answering patient CR questions (mean = 2.29 ± 0.95/5 pre and 3.67 ± 0.58 post; p ≤ 0.001). CR attitudes were significantly more positive post-course (mean = 4.13 ± 0.95/5 pre and 4.62 ± 0.59 post; p ≤ 0.05). With regard to practice, 8 (33.3%) HCPs

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“…Document analysis data were not created for purposes of research and thus are not as rigorous as interviews or focus groups, and important factors may go unmentioned. Although HBCR is more accessible, our program had low referral and enrollment rates, which is a longstanding issue in cardiac rehabilitation programs [24][25][26]. Lastly, a major barrier to adoption of HBCR in the United States is lack of insurance coverage for this type of homebased program.…”

Section: Discussionmentioning

confidence: 99%

Creating and disseminating a home-based cardiac rehabilitation program: experience from the Veterans Health Administration

Wakefield

Drwal

Paez

et al. 2019

BMC Cardiovasc Disord

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Background: Cardiac rehabilitation (CR) programs provide significant benefit for people with cardiovascular disease. Despite these benefits, such services are not universally available. We designed and evaluated a national home-based CR (HBCR) program in the Veterans Health Administration (VHA). The primary aim of the study was to examine barriers and facilitators associated with site-level implementation of HBCR. Methods: This study used a convergent parallel mixed-methods design with qualitative data to analyze the process of implementation, quantitative data to determine low and high uptake of the HBCR program, and the integration of the two to determine which facilitators and barriers were associated with adoption. Data were drawn from 16 VHA facilities, and included semi-structured interviews with multiple stakeholders, document analysis, and quantitative analysis of CR program attendance codes. Qualitative data were analyzed using the Consolidated Framework for Implementation Research codes including three years of document analysis and 22 interviews. Results: Comparing high and low uptake programs, readiness for implementation (leadership engagement, available resources, and access to knowledge and information), planning, and engaging champions and opinion leaders were key to success. High uptake sites were more likely to seek information from the external facilitator, compared to low uptake sites. There were few adaptations to the design of the program at individual sites. Conclusion: Consistent and supportive leadership, both clinical and administrative, are critical elements to getting HBCR programs up and running and sustaining programs over time. All sites in this study had external funding to develop their program, but high adopters both made better use of those resources and were able to leverage existing resources in the setting. These data will inform broader policy regarding use of HBCR services.

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Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

Cited by 50 publications

References 46 publications

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

Implementing recommendations for inpatient healthcare provider encouragement of cardiac rehabilitation participation: development and evaluation of an online course

Creating and disseminating a home-based cardiac rehabilitation program: experience from the Veterans Health Administration

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