Effectiveness of interventions to improve cardiovascular healthcare in rural areas: a systematic literature review of clinical trials

Ruíz-Pérez, Isabel; Bastos, Ángel; Serrano-Ripoll, María Jesús; Ricci‐Cabello, Ignacio

doi:10.1016/j.ypmed.2018.12.012

Cited by 14 publications

(11 citation statements)

References 90 publications

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“…A recent systematic review of clinical trials investigating the effectiveness of interventions to improve the cardiovascular healthcare in rural areas identified eighteen studies that were all conducted in high-income countries [122]. The five studies involving interventions targeting MI were based on organisational changes, such as those mentioned above and aimed to reduce the time to treatment and decrease mortality.…”

Section: Opportunities To Overcome Problems Associated With Managing mentioning

confidence: 99%

“…The interventions evaluated included mobile coronary care units, introduction of a new emergency department in a rural hospital, a new protocol for immediate/urgent transfer of patients for PCI, and the implementation of an AMI clinical pathway incorporating thrombolytic administration in rural emergency departments. While educational interventions improve knowledge and self-care, and organisational interventions can improve healthcare processes, their impact on mortality, and other important health outcomes still remains to be established [122].…”

Section: Opportunities To Overcome Problems Associated With Managing mentioning

confidence: 99%

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Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Thompson

Nedkoff

Katzenellenbogen

et al. 2019

IJERPH

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This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.

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Section: Opportunities To Overcome Problems Associated With Managing mentioning

confidence: 99%

Section: Opportunities To Overcome Problems Associated With Managing mentioning

confidence: 99%

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Thompson

Nedkoff

Katzenellenbogen

et al. 2019

IJERPH

View full text Add to dashboard Cite

show abstract

“…The effects of the implementation of interventions on hospital admissions, the use of health resources [72,101,102], clinical workload and work ow, and dependence on technology for work [103]. Management: Interest in proposing multiple models of patient management (e.g., integrating alternative models), based on evidence, responding to the needs and pro le of patients [68,77].…”

Section: Organizational Aspectsmentioning

confidence: 99%

Telerehabilitation assessment domains and process in chronic diseases: a scoping meta-review

Chapel

Alexandre²,

Héraud³

et al. 2021

Preprint

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Background Telerehabilitation (TR) interventions are receiving increasing attention. They have been evaluated in various scientific areas through systematic reviews. However, there is a lack of data on how to standardize assessment and report on their domains to guide researchers across studies and bring together the best evidence to assess TR for chronic diseases.Aims and Objectives The aim of this study is to identify domains of assessment in TR and to qualitatively and quantitatively analyze how they are examined to gain an overview of assessment in chronic disease and understand the complexity of TR interventions.Methods A scoping meta-review was carried out on 9 databases and gray literature from 2009 to 2019. The keyword search strategy was based on "telerehabilitation", “evaluation", “chronic disease" and their synonyms. All articles were subjected to qualitative analysis using the Health Technology Assessment (HTA) Core Model prior to further analysis and narrative synthesis.Results Among the 7412 identified articles, 80 studies met the inclusion criteria. Regarding the domains of assessment, the most frequently occurring were “social aspect” (n = 63, 79%) (e.g., effects on behavioral changes) and “clinical efficacy” (n = 53, 66%), and the least frequently occurring was “safety aspects” (n= 2, 3%). We also identified the phases of TR in which the assessment was conducted and found that it most commonly occurred in the pilot study and randomized trial phases and least commonly occurred in the design, pretest, and postintervention phases.Conclusions Through the HTA model, this scoping meta-review highlighted the multidisciplinarity and comprehensiveness of TR assessment in the recent literature. Future studies will benefit from approaches that leverage the best evidence regarding the assessment of TR interventions, and it will be interesting to extend this assessment framework to other chronic diseases.

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“…It is reasonable to consider that this kind of programs may be effective in providing better care to patients living in isolated areas. Nevertheless, a recent systematic review did not describe a clear effect on mortality derived from such interventions in rural areas 32 . In our region, for the present, the impact of these programs has only been reported for urban areas.…”

Section: Mortalitymentioning

confidence: 99%

Effect of the Place of Living on Mortality in Patients with Advanced Heart Failure

Muñoz

García

Navas

et al. 2020

Preprint

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BackgroundSocial and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.MethodsPopulation-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least one year after reaching New York Heart Association IV, between 2010 and 2014.Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality.ResultsMean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged >74 years (p=0.036), and presented lower comorbidity. Mortality percentages were 59% and 51% among rural and urban patients, respectively (p=0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend <0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.ConclusionsLiving in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

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Effectiveness of interventions to improve cardiovascular healthcare in rural areas: a systematic literature review of clinical trials

Cited by 14 publications

References 90 publications

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Telerehabilitation assessment domains and process in chronic diseases: a scoping meta-review

Effect of the Place of Living on Mortality in Patients with Advanced Heart Failure

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