Abstract
BackgroundThere is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences.MethodsA systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources.ResultsSeven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were ‘the organisation of healthcare system’, ‘the organisation of cardiac rehabilitation programmes’, ‘healthcare professional’ factors and ‘guidelines’. The most frequent themes included ‘lack of resources: time, staff, facilities and equipment’ and ‘professional’s knowledge, awareness and attitude’.ConclusionsOur systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research.
Highlights
There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure
The literature that we reviewed did not report characteristics of the patient populations served or consider how barriers might vary depending on patient characteristics
This systematic review identified a broad range of provider- and service-level factors affecting the delivery of cardiac rehabilitation for heart failure
Summary
There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. There is a substantial human cost of heart failure, as many patients experience a diminished quality of life related to their illness [3]. Key strategies for improving health-related quality of life include self-management of symptoms and psychological consequences of heart failure and exercise-based rehabilitation of physical functioning, all of which are part of comprehensive cardiac rehabilitation programmes. Several trials and systematic reviews have confirmed the safety and effectiveness (reduction in hospital admissions and improvement in health-related quality of life) of cardiac rehabilitation for heart failure [5,6,7]. Cardiac rehabilitation programmes are an effective and cost-effective strategy for improving health-related quality of life in people with heart failure [8, 9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
