Why Do Patients With Ischaemic Heart Disease Drop Out From Cardiac Rehabilitation in Primary Health Settings. A Qualitative Audit of Patient Charts

Ravn, Maiken Bay; Uhd, Maria; Svendsen, Marie Louise; Ørtenblad, Lisbeth; Maribo, Thomas

doi:10.3389/fresc.2022.837174

Cited by 4 publications

(11 citation statements)

References 24 publications

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“…This study supports previous findings indicating the need for enhanced cross-sectoral collaboration between the referring hospital and the delivering primary healthcare centre of CR with the objective to promote CR uptake and adherence 12 29 30. Furthermore, health professionals should communicate to patients that CR is an important part of the secondary prevention and provide comprehensive information regarding the various CR activities 12 29 30. Future research on interventions to promote CR utilisation among patients with low SES is warranted 7 8…”

Section: Discussionsupporting

confidence: 86%

To what extent is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study

et al. 2022

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ObjectivesHigh socioeconomic status (SES) has been linked to high referral for cardiac rehabilitation (CR). However, the impact of SES on CR utilisation from enrolment to completion is unclear. The objective of this study was to examine whether indicators of SES are associated with not taking up and dropout from CR.DesignA population-based, follow-up study.SettingHospitals and primary healthcare centres in the Central Denmark Region.ParticipantPatients diagnosed with ischaemic heart disease (IHD) in the hospital and referred for rehabilitation in the primary healthcare setting from 1 September 2017 to 31 August 2018 (n=2018).VariablesFour SES indicators (education, disposable family income, occupation and cohabitant status) were selected because of their established association with cardiovascular health and CR utilisation. Patients were followed up regarding no uptake of or dropout from CR in the primary healthcare setting.Statistical methodsThe associations between the four SES indicators and either no uptake or dropout from CR were analysed using logistic regression with adjustment for age, sex, nationality and comorbidity.ResultsOverall, 25% (n=507) of the referred patients did not take up CR and 24% (n=377) of the participators dropped out the CR. All adjusted ORs, except one (education/dropout) demonstrated that low SES compared with high are statistically significantly associated with higher odds of not taking up CR and dropout from CR. The ORs ranged from 1.52, 95% CI 1.13 to 2.04 (education/no uptake) to 2.36, 95% CI 1.60 to 3.46 (occupation/dropout).ConclusionsThis study highlights that indicators of SES are important markers of CR utilisation following hospitalisation for IHD.

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Section: Discussionsupporting

confidence: 86%

To what extent is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study

et al. 2022

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“…As demonstrated in a previous, related study, comorbidities act as a barrier to adherence to CR ( 15 ). Health professionals point out the importance of other contextual factors, including the patient's family and job situation.…”

Section: Resultsmentioning

confidence: 70%

“…Other contextual factors such as a lack of flexible hours was a barrier identified in a study ( 15 ). This was also identified by the health professionals.…”

Section: Resultsmentioning

confidence: 96%

“…1.5 h. Focus group discussions were initiated with an introduction of all present. A semi-structured interview guide based on results from a qualitative audit of patient's causes for dropout was developed to facilitate discussions ( 15 ). An overview of the link between this study and the audit is presented in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

“…The aim of the present study was to explore health professional's perspectives on how to facilitate CR adherence. Patient's reasons for drop-out were examined in a previous study ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

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How to Facilitate Adherence to Cardiac Rehabilitation in Primary Health Settings for Ischaemic Heart Disease Patients. The Perspectives of Health Professionals

Ravn¹,

Uhd²,

Svendsen³

et al. 2022

Front. Rehabilit. Sci.

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BackgroundCardiac rehabilitation (CR) is a class 1A recommendation and an integrated part of standard treatment for patients with cardiac disease. In Denmark, CR adheres to European guidelines, it is group-based and partly conducted in primary health settings. Despite high evidence for the benefits of CR, it remains underutilized. How to facilitate CR adherence in primary health settings is poorly understood.AimThis study explores health professional's perspectives on how to facilitate CR adherence for patients with ischaemic heart disease in primary health settings.MethodsData were collected through focus group discussions. Respondents were health professionals specialized in and working with CR in primary health settings. Data were analyzed using thematic analysis.ResultsEleven health professionals participated in two focus group discussions. Five themes emerged as facilitators of CR; (1) placing the person at the center, (2) coherent programme, (3) flow of information, (4) contextual factors, and (5) feeling of belonging.ConclusionThis study illuminates the complexity of facilitating adherence to CR in primary health settings and provides ways in which health professionals may facilitate adherence. Placing the person at the center is pivotal and may be done by adapting CR offers to patients' social context, culture and life circumstances and ensuring a feeling of belonging. The rhetoric related to CR should be positive and throughout the entire course of treatment health professionals should possess a generic and collective approach to and view of CR. Perceiving these elements as potential facilitators is of vital importance and addressing them may facilitate adherence.

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Patient's learning needs and self‐efficacy level after percutaneous coronary intervention: A descriptive study

Salgado

Paulo

Zufferey

et al. 2023

Journal of Clinical Nursing

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Aims and ObjectivesIdentify and compare learning needs, levels of self‐efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital.BackgroundAfter primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self‐efficacy must be considered when developing effective therapeutic patient education (TPE).MethodsLearning needs and self‐efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self‐Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross‐sectional studies was used in reporting this study.ResultsNinety‐three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p < .001. In both units, participants declared that the most important need was related to ‘anatomy and physiology’ of the heart. Despite the high score, the least important need was about ‘physical activity’ for inpatients and ‘miscellaneous information’ for outpatients. No statistically significant differences were found among patients from both units regarding their self‐efficacy level.ConclusionsThis study shows that after PCI, patients have high learning needs and moderate levels of self‐efficacy that require addressing.Relevance to Clinical PracticePatient's individual learning needs and self‐efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self‐efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process.No Patient or Public ContributionFor feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research.

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Why Do Patients With Ischaemic Heart Disease Drop Out From Cardiac Rehabilitation in Primary Health Settings. A Qualitative Audit of Patient Charts

Cited by 4 publications

References 24 publications

To what extent is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study

To what extent is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study

How to Facilitate Adherence to Cardiac Rehabilitation in Primary Health Settings for Ischaemic Heart Disease Patients. The Perspectives of Health Professionals

Patient's learning needs and self‐efficacy level after percutaneous coronary intervention: A descriptive study

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