Participation and adherence to cardiac rehabilitation programs. A systematic review

Ruano-Raviña, Alberto; Peña‐Gil, Carlos; Abu-Assi, Emad; Raposeiras, Sergio; Hof, Arnoud van ’t; Meindersma, Esther P.; Prescott, Eva; González-Juanatey, José Ramón

doi:10.1016/j.ijcard.2016.08.120

Cited by 311 publications

(291 citation statements)

References 43 publications

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“…Despite the apparent health benefits, approximately 62% of countries worldwide do not offer CR, due to insufficient health resources and non-compatible health policies (Turk-Adawi, Sarrafzadegan, & Grace, 2014). CR programmes are underused, as only 14-35.5% patients participate, due to inadequate professional referral, travelling issues and time conflicts with other life priorities (Ruano-Ravina et al, 2016). eHealth CR, which delivers CR using ICT, has evolved as an innovative model to improve the availability and accessibility of this important model of care.…”

Section: Introductionmentioning

confidence: 99%

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta‐analysis

Paguio

2020

Journal of Advanced Nursing

101

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Aims To evaluate the effects of eHealth cardiac rehabilitation (CR) on health outcomes of coronary heart disease patients and to identify programme design, which may lead to more effective health benefits. Design A systematic review and meta‐analysis following Cochrane Handbook for Systematic Reviews of Interventions. Data sources Medline, EMBASE, CLNAHL, Web of Science, Scopus, PsycINFO, Cochrane Central Register of Controlled Trails, PubMed and CNKI were searched over the period from 1806 to April 2019. Review methods A systematic review and meta‐analysis of randomized controlled trials to examine the effect of eHealth CR on health outcomes of coronary heart disease patients. We used RevMan 5.3 for risk of bias assessment and meta‐analysis and GRADE software for generating findings. Results In all, 14 trials with 1,783 participants were included. eHealth CR has significantly promoted duration of physical activity, daily steps, quality of life (QoL) and re‐hospitalization. Using comparative analysis of programme design elements, including mode of delivery, intervention content, motivational strategies and social support, between the effective and ineffective eHealth CR, it was found that comprehensive empowerment strategies and follow‐up care by tele‐monitoring may be the crucial characteristics leading to more favourable treatment effect. Conclusion eHealth CR is effective in engaging patients in active lifestyle, improving QoL and reducing re‐hospitalization. Future research needs to test the effects of comprehensive CR programmes by incorporating empowerment strategies and tele‐monitoring as active components. Impact eHealth has been increasingly applied to increase accessibility and uptake of CR. Integrative evidence to indicate its effects on health outcomes is lacking. This review identified its positive effects on some behavioural, psychosocial and health service use outcomes. Together with insights about which programme design elements may positively shape the outcomes, this review informs the role and practice of cardiovascular nurses in promoting evidence‐based eHealth CR.

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Section: Introductionmentioning

confidence: 99%

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta‐analysis

Paguio

2020

Journal of Advanced Nursing

101

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“…Although cardiac rehabilitation after a cardiovascular event is a Class I recommendation of the European Society of Cardiology, the American Heart Association and the American College of Cardiology, it remains vastly underutilized, ranging from 15% to 50% of the targeted population participating in such services …”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] Although cardiac rehabilitation after a cardiovascular event is a Class I recommendation of the European Society of Cardiology, the American Heart Association and the American College of Cardiology, it remains vastly underutilized, ranging from 15% to 50% of the targeted population participating in such services. [10][11][12][13][14] Acute coronary syndrome patients usually have high prevalence of risk factors, such as polypharmacy applied by multiple prescribers, several comorbidities and inadequate education about their treatment plan which predispose them to drug-related problems (DRPs). 15 Drug-related problems are drug issues that interfere with achievement of optimal outcome.…”

Section: Introductionmentioning

confidence: 99%

Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

Casper

Wakeel

Saleh

et al. 2019

Basic Clin Pharma Tox

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Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide and negatively impacts healthcare costs, productivity and quality of life. Polymorbidity and polypharmacy predispose ACS patients to medication discrepancies between cardiologist‐prescribed medication and drug use by the patient, drug‐related problems (DRPs) and inadequate drug adherence. This study aimed to evaluate the impact of clinical pharmacist–provided services on the outcome of ACS patients. This was a prospective, randomized, controlled study on ACS patients participating in a cardiac rehabilitation programme. Forty ACS patients were randomly assigned to either control group, who received standard medical care, or intervention group, who received standard medical care plus clinical pharmacist–provided services. Services included DRP management, clinical assessment and enforcing the patient education and adherence. For both groups, the following were assessed at baseline and after 3 months: DRPs, adherence (assessed by 8‐item Morisky Adherence Questionnaire), patient's knowledge (assessed by Coronary Artery Disease Questionnaire), 36‐Short Form Health Survey (SF‐36), heart rate, systolic and diastolic blood pressure, low‐density lipoprotein (LDL), total cholesterol (TC) and fasting blood glucose (FBG). After 3 months, there was a significant difference between the intervention and control groups in the per cent change of DRPs (median: −100 vs 5.882, P = 0.0001), patient's adherence score (median: 39.13 vs −14.58, P = 0.0001), knowledge score (median: 30.28 vs −5.196, P = 0.0001), SF‐36 scores, heart rate (mean: −10.04 vs 6.791, P = 0.0001), diastolic blood pressure (mean: −17.87 vs 10.45, P = 0.0001), systolic blood pressure (mean: −16.22 vs 4.751, P = 0.0001), LDL (median: −25.73 vs −0.2538, P = 0.0071), TC (median: −14.62 vs 4.123, P = 0.0005) and FBG (median: −11.42 vs 5.422, P = 0.0098). Clinical pharmacists can play an important role as part of a cardiac rehabilitation team through patient education and interventions to minimize DRPs.

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“…We are not aware of any studies investigating the impact of sociodemographic variables on rehabilitation use in MS. However, in other illness groups, such as myocardial infarction, results of a systematic review demonstrate that demographic variables such as age, sex, employment status, education, and income clearly affect participation in and adherence to cardiac rehabilitation programs(Ruano-Ravina et al, 2016). Focusing on social roles and patients' life contexts, which are related to sociodemographic variables to some degree,Helland et al (2015) showed, in their qualitative study in patients with MS, that practical barriers in a patient's work or family life, such as caring for small children or other family members, prohibited a rehabilitation stay.…”

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confidence: 99%

Rehabilitation use in multiple sclerosis: Do illness representations matter?

et al. 2018

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ObjectivesMultidisciplinary rehabilitation improves illness outcomes and is recommended in clinical guidelines for multiple sclerosis (MS). However, many people with MS do not make use of rehabilitation. We do not know much about the barriers to the use of rehabilitation in MS, but in other patient groups, illness representations have proven to be predictors of service utilization. Therefore, the aim of our study was to explore whether, in patients with MS, illness representations are associated with self‐reports of rehabilitation use in the past and the intention to use rehabilitation in the future, beyond sociodemographic and illness‐related factors.Materials and MethodsPatients were recruited in a cross‐sectional nationwide online survey in Germany. Hierarchical binary logistic regression analysis was used to analyze whether illness representations are associated with the use of rehabilitation in the past and the intention to use rehabilitation in the future, over and above socio‐demographic and illness‐related variables.ResultsThere were 590 patients, who had MS, participating in the study. Illness representations were correlated to both outcome variables beyond sociodemographic and illness‐related factors: The probabilities of having the intention to use rehabilitation and of making using of rehabilitation were higher in patients who believed that their MS was controllable by treatment and perceived that their MS would have severe consequences.ConclusionsOur data suggest that addressing patients’ illness representations may facilitate the intention to use and the use of multimodal rehabilitation, contributing to better illness outcomes.

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Participation and adherence to cardiac rehabilitation programs. A systematic review

Cited by 311 publications

References 43 publications

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta‐analysis

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta‐analysis

Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

Rehabilitation use in multiple sclerosis: Do illness representations matter?

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