Promoting participation in cardiac rehabilitation: patient choices and experiences (original) (raw)
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Barriers to participation in cardiac rehabilitation
American Heart Journal, 2009
Background-Participation rates in cardiac rehabilitation following myocardial infarction (MI) remain low. Studies investigating the predictive value of psychosocial variables are sparse and often qualitative. We aimed to examine the demographic, clinical, and psychosocial predictors of participation in cardiac rehabilitation after MI in the community. Methods-Olmsted County, Minnesota residents hospitalized with MI between June 2004 and May 2006 were prospectively recruited, and a 46-item questionnaire was administered prior to hospital dismissal. Associations between variables and cardiac rehabilitation participation were examined using logistic regression. Results-Among 179 survey respondents (mean age 64.8 years, 65.9% male), 115 (64.2%) attended cardiac rehabilitation. The median (25 th-75 th percentile) number of sessions attended within 90 days of MI was 13 (5-20). Clinical characteristics associated with rehabilitation participation included younger age (odds ratio [OR] 0.95 per 1-year increase), male sex (OR 1.93), lack of diabetes (OR 2.50), ST elevation MI (OR 2.63), receipt of reperfusion therapy (OR 7.96), in-hospital cardiologist provider (OR 18.82), no prior MI (OR 4.17), no prior cardiac rehabilitation attendance (OR 3.85), and referral to rehabilitation in the hospital (OR 12.16). Psychosocial predictors of participation included placing a high importance on rehabilitation (OR 2.35), feeling that rehabilitation was necessary (OR 10.11), better perceived health prior to MI (excellent vs. poor OR 7.33), the ability to drive (OR 6.25), and post-secondary education (OR 3.32). Conclusions-Several clinical and psychosocial factors are associated with decreased participation in cardiac rehabilitation programs after MI in the community. As many are modifiable, addressing them may improve participation and outcomes.
Improving the uptake of cardiac rehabilitation – redesign the service or rewrite the invitation?
British Journal of Cardiology
For patients with established coronary artery disease, lifestyle changes such as dietary modification, smoking cessation, stress management and regular exercise, can help to reduce, or perhaps stop, the progression of their cardiovascular disease, reduce their chance of having another cardiac event, and improve their quality of life. Cardiac rehabilitation can accelerate physical and psychological recovery and reduce mortality after acute cardiac events by 10–25% according to systematic reviews of randomised trials. 1-3 Cardiac rehabilitation programmes can also reduce risk factors, improve health-related quality of life, and increase the likelihood of return to work. 3-6 Despite this evidence, however, typically fewer than 35% of eligible patients take part in cardiac rehabilitation worldwide, with a recent UK audit reporting figures in line with this. 7-10 Numerous studies have demonstrated and explored the complex factors associated with low attendance at cardiac rehabilitation. ...
Participating or not in a cardiac rehabilitation programme: factors influencing a patient's decision
European journal of preventive cardiology, 2013
International research indicates that attendance of patients to a proposed cardiac rehabilitation (CR) programme varies between 21% and 75%. Addressing the reasons why cardiac patients are not participating will improve accessibility to CR. The objective of this study was to investigate patient compliance with cardiac rehabilitation and the reasons of refusing or abandoning the programme. Twenty hospital centres were recruited to participate. Each centre was asked to recruit patients from three patient groups, namely: percutaneous coronary intervention patients, patients that underwent major cardiac surgery, and patients being admitted because of an acute myocardial infarction and not belonging to the other two groups. Patients were asked to fill out a questionnaire during a follow-up outpatient consultation after the cardiac intervention. In total, 226 patients participated in the survey. Most patients were proposed (86%) and accepted (81% out of proposed) to attend a CR programme....
Progress in Cardiovascular Nursing, 2002
Despite the documented evidence of the benefits of cardiac rehabilitation (CR) in enhancing recovery and reducing mortality following a myocardial infarction, only about one third of patients participate in such programs. Adherence to these programs is an even bigger problem, with only about one third maintaining attendance in these programs after 6 months. This review summarizes research that has investigated barriers to participation and adherence to CR programs. Some consistent factors found to be associated with participation in CR programs include lack of referral by physicians, associated illness, specific cardiac diagnoses, reimbursement, self-efficacy, perceived benefits of CR, distance and transportation, self-concept, self-motivation, family composition, social support, self-esteem, and occupation. Factors associated with non-adherence include being older, female gender, having fewer years of formal education, perceiving the benefits of CR, having angina, and being less physically active during leisure time. However, many of the studies have methodologic flaws, with very few controlled, randomized studies, making the findings tentative. Problems in objectively measuring adherence to unstructured, non-hospital-based programs, which are an increasingly popular alternative to traditional programs, are discussed. Suggestions for reducing barriers to participation and adherence to CR programs, as well as for future research aimed at clearly identifying these barriers, are discussed.
Outpatient cardiac rehabilitation: Patient perceived benefits and reasons for non-attendance
Collegian, 2018
Objective: To determine patients' perceptions of the benefits of participating in outpatient cardiac rehabilitation and the reasons why some decline to take part. Method: Data collected included patients' responses to the self-administrated 'Outpatient Cardiac Rehabilitation Program Evaluation' form, after attending a cardiac rehabilitation program. The evaluation involved analysis of 9 binary and open ended questions. A retrospective study was completed on data collected from January 2010 to December 2015 (6 years) and included 643 adult cases comprising 500 men and 143 women. A between subject t-Test was used to compare patient means before and after attendance of perceived changes to their lifestyle, and overall sense of physical and emotional wellbeing. Fishers Exact Test was used to compare attendance percentages, gender distribution, and primary diagnosis. Results: Two hundred and seventy nine (43.4%) of the 643 invited patients participated in the cardiac rehabilitation program, while 364 (56.6%) declined, with this result being significantly lower (p < 0.001) than those reported in other Australian locations. The sex distribution of those that participated was 234 (83.8%) males and 45 (16.2%) females while those that declined were 266 (73.1%) males and 98 (23.9%) females. The male prevalence of both attendance and non-attendance was significant (p < 0.001). Patients with a primary referral diagnosis of having a percutaneous coronary intervention and acute myocardial infarction were significantly (p < 0.05) more likely to decline cardiac rehabilitation. Of those who participated, 96.1% indicated they received benefits from attending the cardiac rehabilitation program, with 96.8% identifying significant changes to their lifestyle (p < 0.01) and sense of well-being improvement (p < 0.001) as key benefits, in addition to perceived quicker recovery. According to participants, these positive outcomes resulted from a healthier diet, exercise, better stress management, and support from other patients with similar conditions. The major reasons for declining participation was 'not wanting to attend' (19.3%), 'referred to another hospital service' (10.6%), and 'work related commitments' (7.3%). Conclusion: Considering the reported benefits of attending cardiac rehabilitation, the number of people who decline to attend has important implications for their health and related health system costs related to ongoing disease.
A controlled intervention to increase participation in cardiac rehabilitation
European journal of preventive cardiology, 2014
Cardiac rehabilitation programs are greatly underutilized. This study was a multicenter interventional controlled cohort study. From cardiothoracic departments of five medical centers, 520 coronary artery bypass graft (CABG) patients (386 men) were enrolled in the control arm and 504 CABG patients (394 men) in the intervention arm of our study. A 1-hour seminar to medical staff on the benefits of cardiac rehabilitation followed the control phase and preceded the intervention phase. Patients in the intervention arm received written and oral explanations on cardiac rehabilitation benefits and eligibility, and a follow-up telephone call 2 weeks after hospital discharge. Patients in both study arms were interviewed in the hospital prior to CABG surgery and in their homes a year later. Rates of participation in cardiac rehabilitation were 16.5% (86/520) for the control arm and 31.0% (156/504) for the intervention arm (p < 0.001). Factors strongly associated with participation in cardi...
Facilitators and Barriers in Cardiac Rehabilitation Participation: An Integrative Review
The Journal for Nurse Practitioners, 2011
Too many patients with cardiovascular disease do not elect recommended cardiac rehabilitation (CR). This integrative literature review includes 16 peer-reviewed articles and describes factors associated with the use of CR. The Health Promotion Model guided synthesis of findings. Barriers and facilitators to participating in CR, characteristics of typical CR clients, and clinical implications of findings for the advanced practice nurse
European Journal of Cardiovascular Nursing, 2008
Background: In spite of the benefit in participating in cardiac rehabilitation (CR) programs, low participation rates are well documented. Participation rates are potentially lower in people who have undergone percutaneous coronary interventions (PCI). Assessment of the barriers to CR participation in PCI patients could provide vital information for the development of alternate strategies for coronary risk factor modification. Aim: The aim of this study was to develop and evaluate the psychometric properties of a scale to assess obstacles to cardiac rehabilitation enrolment in patients following PCI. Methods: Item generation for the 15 items of this scale was based on a comprehensive review of the literature and data collected from telephone interviews of CR coordinators related to cardiac rehabilitation enrolment obstacles (CREO). Content validity of the scale was undertaken using a reference group comprising of clinicians and patients. Construct validity was undertaken using a factor analysis. Data for the CREO scale was collected from December 2004 to March 2005 from 114 PCI patients recruited from a cardiology database in a Sydney metropolitan hospital. Results: Factor analysis revealed a two-factor structure: patient-related obstacles and health service-related obstacles, which accounted for 58% of cumulative explained variance. The scale showed good internal consistency (Cronbach's alpha = 0.89) and satisfactory divergent validity. Conclusion: This scale can be used as a useful tool for the early identification of patients who would not normally enrol into CR and offer them alternate strategies for health-related lifestyle modification.