Factors influencing the uptake of cardiac rehabilitation by cardiac patients with a comorbidity of stroke

Harrison, Alexander; Gaskins, N; Connell, Louise; Doherty, Patrick

doi:10.1016/j.ijcha.2020.100471

Cited by 8 publications

(8 citation statements)

References 12 publications

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“…The finding of reduced social participation after stroke during the first wave COVID-19 lockdown was expected, since social isolation and shielding were the primary public health strategies to reduce viral spread, impacting on many social aspects of life [38,39]. Worryingly, social isolation has adverse effects on rehabilitation compliance, engagement in activities of daily living, anxiety and premature death amongst stroke patients [40][41][42][43]. However, data on how mandatory isolation affects stroke survivor's social participation are extremely limited [7,25].…”

Section: Discussionmentioning

confidence: 99%

The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

et al. 2021

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Background and purpose The COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke. Methods This retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March–16th May 2018 (pre-COVID-19 pandemic); and 16th March–16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System–29 (PROMIS-29 version 2.0) at 30 days after stroke. Results We included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (β = 28.0, p < 0.001), fatigue (β = 9.3, p < 0.001), depression (β = 4.5, p = 0.002), sleep disturbance (β = 2.3, p = 0.018), pain interference (β = 10.8, p < 0.001); and reduced physical function (β = 5.2, p < 0.001) and participation in social roles and activities (β = 6.9, p < 0.001). Conclusion Compared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health.

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Section: Discussionmentioning

confidence: 99%

The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

et al. 2021

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“…[4][5][6][7][8] Prior research in CR has identified multiple patient characteristics associated with CR uptake, including age, gender, ethnicity, relationship status, comorbidities and social deprivation. [38][39][40] Further research should aim to recruit larger and more varied samples, for example targeting poorly served and under-represented groups, to more thoroughly assess how preferences differ by group. DCE targeted in these populations has potential to inform adaptations in service delivery to increase access and health across the wider population accessing CR.…”

Section: Discussionmentioning

confidence: 99%

“…Preference heterogeneity, within samples, has been noted to be an issue in previous DCEs in this area 4–8. Prior research in CR has identified multiple patient characteristics associated with CR uptake, including age, gender, ethnicity, relationship status, comorbidities and social deprivation 38–40. Further research should aim to recruit larger and more varied samples, for example targeting poorly served and under-represented groups, to more thoroughly assess how preferences differ by group.…”

Section: Discussionmentioning

confidence: 99%

Discrete choice experiment to investigate preferences for psychological intervention in cardiac rehabilitation

et al. 2022

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ObjectiveCardiac rehabilitation (CR) is offered to people who recently experienced a cardiac event, and often comprises of exercise, education and psychological care. This stated preference study aimed to investigate preferences for attributes of a psychological therapy intervention in CR.MethodsA discrete choice experiment (DCE) was conducted and recruited a general population sample and a trial sample. DCE attributes included the modality (group or individual), healthcare professional providing care, information provided prior to therapy, location and the cost to the National Health Service (NHS). Participants were asked to choose between two hypothetical designs of therapy, with a separate opt-out included. A mixed logit model was used to analyse preferences. Cost to the NHS was used to estimate willingness to pay (WTP) for aspects of the intervention design.ResultsThree hundred and four participants completed the DCE (general public sample (n=262, mean age 47, 48% female) and trial sample (n=42, mean age 66, 45% female)). A preference for receiving psychological therapy was demonstrated by both samples (general population WTP £1081; 95% CI £957 to £1206). The general population appeared to favour individual therapy (WTP £213; 95% CI £160 to £266), delivered by a CR professional (WTP £48; 9% % CI £4 to £93) and with a lower cost (β=−0.002; p<0.001). Participants preferred to avoid options where no information was received prior to starting therapy (WTP −£106; 95% CI −£153 to −£59). Results for the location attribute were variable and challenging to interpret.ConclusionsThe study demonstrates a preference for psychological therapy as part of a programme of CR, as participants were more likely to opt-in to therapy. Results indicate that some aspects of the delivery which may be important to participants can be tailored to design a psychological therapy. Preference heterogeneity is an issue which may prevent a ‘one-size-fits-all’ approach to psychological therapy in CR.

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“…Stroke and cardiac disorders are difficult to approach separately for several reasons [ 5 ]. First, stroke and heart disease have similar etiologies and risk factors [ 1 2 3 ]. Second, perioperative stroke is also a major and common complication of cardiac surgery [ 6 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Stroke and heart disease share similar underlying pathophysiology and risk factors; diabetes, hyperlipidemia, smoking, physical inactivity, and obesity are known to increase the risk of both [ 1 2 3 ]. Stroke survivors commonly have cardiovascular comorbidities [ 4 5 ].…”

Section: Introductionmentioning

confidence: 99%

Integrating Cardiac Rehabilitation with Neurorehabilitation in a Patient with Ischemic Stroke after Cardiac Surgery: a Case Report

Jung

Lee

2021

Brain Neurorehabil

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Factors influencing the uptake of cardiac rehabilitation by cardiac patients with a comorbidity of stroke

Cited by 8 publications

References 12 publications

The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

Discrete choice experiment to investigate preferences for psychological intervention in cardiac rehabilitation

Integrating Cardiac Rehabilitation with Neurorehabilitation in a Patient with Ischemic Stroke after Cardiac Surgery: a Case Report

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