Inclusion of People Poststroke in Cardiac Rehabilitation Programs in Canada: A Missed Opportunity for Referral

Toma, Jelena; Hammond, Brittany; Chan, V. W. S.; Peacocke, Alex; Salehi, Baharak; Jhingan, Prateek; Brooks, Dina; Hébert, Andrée-Anne; Marzolini, Susan

doi:10.1016/j.cjco.2020.01.007

Cited by 22 publications

(33 citation statements)

References 41 publications

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“…Ten CRP managers represented 3 to 12 separate CRPs and data were reported by respondent. CRPs are available in 10 of Canada’s 13 provinces and territories with no programs in the North, 11 and surveys were completed by CRP representatives from all 10 provinces (100%). It is reported that there are 182 CRPs in Canada, 12 thus our study sample represents 79.1% of all programs.…”

Section: Resultsmentioning

confidence: 99%

Cardiac Rehabilitation in Canada During COVID-19

Marzolini¹,

Ghisi²,

Hébert³

et al. 2021

CJC Open

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Background /Methods: To examine the status of cardiac rehabilitation programs (CRPs) during COVID-19, a web-based questionnaire was completed by CRP managers from April 23 rd -May 14 th 2020. Results Overall, 114 representatives of 144 CRPs (79.1% of Canadian programs) responded. Of respondents, 41.2% (n=47) reported CRP closure; primary reasons were staff redeployment and facility closure (41% of 51 responses, both). Redeployment occurred in open-CRPs and closed-CRPs (30±34% and 47±38% of employees respectively;p=.05) and reduced hours in 17.8±31% and 22.5±33% of remaining employees;p=.56. Of open-CRPs, 84.8% accepted referrals for medically high-risk patients pre-COVID-19; falling to only 43.5% during-COVID-19;p<.001. There was a significant reduction in patients with cognitive/communication/mobility deficits being eligible to participate during-COVID-19. Of respondents, 57%-82.6% reported safety concerns for prescribing exercise to medically high-risk and vulnerable populations. CRPs transitioned from group-based to one-to-one delivery models; >80% by phone and/or e-mail. Any tele-rehabilitation (one-to-one/group) was also used by 32.7% and 43.5% of CRPs to deliver exercise and education respectively (mostly one-to-one). Resource barriers cited by open- and closed-CRPs were related to technology; no tele-rehabilitation, lack of equipment and patient access (35% of all barriers) while 25.3% of barriers were owing to greater demands on staff time. Conclusion Within 2-months of COVID-19 being declared a pandemic, 41.2% of CRPs were closed and almost half of employees redeployed. Less time-efficient one-to-one models of remote care mostly by phone/e-mail were adopted. Vulnerable populations were disproportionately affected becoming ineligible owing to safety concerns. Strategies to open closed-CRPs, admitting high risk/vulnerable populations, and offering group-based tele-rehabilitation should be a national priority. Brief Summary An increase in patients with complex cardiac conditions referred to cardiac rehabilitation programs (CRPs) is expected given delayed treatment and cardiac involvement related to COVID-19. Yet, ∼half of employees were redeployed and 41% of Canadian CRPs closed. There was a marked decrease in open-CRPs accepting referrals for high medical-risk and vulnerable patients. Developing policy that provides strategies to open closed-CRPs, admitting high risk/vulnerable populations, and offering group-based tele-rehabilitation should be a national priority.

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Section: Resultsmentioning

confidence: 99%

Cardiac Rehabilitation in Canada During COVID-19

Marzolini¹,

Ghisi²,

Hébert³

et al. 2021

CJC Open

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“…Facilitators recommended by CR managers to increase referral of individuals with stroke to CR programs included collaboration with health care professionals from stroke rehabilitation units. 66 Indeed, a recent study by our group demonstrated that collaboration between CR and a single stroke rehabilitation program resulted in~3/4 of eligible stroke patients participating in CR, 50 reaching the recommended target set by CR associations and national initiatives. 67 Future studies should examine the effect of CRstroke rehabilitation partnerships nationally and the adoption of an automatic referral process where every patient post-stroke would be considered for referral to CR.…”

Section: Future Directionsmentioning

confidence: 97%

“…50,60,65 Unfortunately, while 65% of Canadian CR programs accept referrals for people post-stroke, 63% of these report that <11 patients participated in the previous year. 60,66 Yet over half of all CR programs were within a 25-km radius of an outpatient stroke rehabilitation program. Facilitators recommended by CR managers to increase referral of individuals with stroke to CR programs included collaboration with health care professionals from stroke rehabilitation units.…”

Section: Future Directionsmentioning

confidence: 99%

A Gap in Post-Stroke Blood Pressure Target Attainment at Entry to Cardiac Rehabilitation

Sawicki

Marzolini

2020

Can. J. Neurol. Sci.

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Background: Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets. Methods: A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006–2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets. Results: Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3–4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke. Conclusions: Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.

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“…In this issue of CJC Open , Toma et al. 7 report results from a large national survey of stroke patients’ participation in CR programs. The authors aimed to characterize poststroke engagement in CR, highlight individual program offerings, and identify barriers/facilitators to patient participation.…”

mentioning

confidence: 99%

“…Many of the stroke survivors discussed in the article by Toma et al. 7 are well past the point (median 11 years after stroke) when we would not expect to see much in the way of neurologic recovery, unless they spent several hours daily performing hundreds of movements to develop new skills. 11 …”

mentioning

confidence: 99%