Aspects Of Cardiac Rehabilitation Research Articles

A nationwide survey on participation in cardiac rehabilitation among patients with coronary heart disease using health claims data in Japan

Poor implementation and variable quality of cardiac rehabilitation (CR) for coronary heart disease (CHD) have been a global concern. This nationwide study aimed to clarify the implementation of and participation in CR among CHD patients and associated factors in Japan. We conducted a retrospective cohort study using data extracted from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in 2017–2018 were included. Aspects of CR were assessed in terms of (1) participation in exercise-based CR, (2) pharmacological education, and (3) nutritional education. Of 87,829 eligible patients, 32% had participated in exercise-based CR, with a mean program length of 40 ± 71 days. CABG was associated with higher CR participation compared to PCI (OR 10.2, 95% CI 9.6–10.8). Patients living in the Kyushu region were more likely to participate in CR (OR 2.59, 95% CI 2.39–2.81). Among patients who participated in CR, 92% received pharmacological education, whereas only 67% received nutritional education. In Japan, the implementation of CR for CHD is insufficient and involved varying personal, therapeutic, and geographical factors. CR implementation needs to be promoted in the future.

A Brief Note on Preventive Cardiology and Cardiac Rehabilitation

Cardiovascular disease is the major cause of death. It has reached epidemic proportions and requires to be addressed through primary and secondary interception measures. The field of preventive cardiology and cardiac rehabilitation is in its developing stages in India and these assistances require to expand widely for the country to effectively manage this epidemic. The aspect focusses on the various aspects of cardiac rehabilitation, including cardiovascular disease risk factor reduction, role of exercise in reducing cardiac morbidity and mortality, and the appropriate exercise prescription for those with heart disease.

Barriers physicians face when referring patients to cardiac rehabilitation: a narrative review.

While cardiac rehabilitation (CR) has been shown to be a beneficial form of secondary prevention for patients with cardiovascular disease, barriers of referral to CR still exist for patients. Barriers that specifically make it difficult for physicians to make the referral could be worthwhile to examine. This narrative review hypothesizes that increasing awareness and education on the various aspects of CR as well as simplifying the referral process could lead to increased referral rates as they target physician-related barriers. This narrative review seeks to further understand the physician-related barriers of low CR awareness and hindering referral processes. A search in Scopus was conducted with preference for articles examining CR referral strategies used by physicians; physicians' awareness of CR programs; physicians' perceptions, beliefs, or knowledge of the benefits of CR; or physicians' experience with or understanding of the selection process of CR programs, including indications for referral. Two systematic reviews and two observational studies were selected for discussion. Three of the selected studies had findings supporting the notion that increasing physicians' awareness of CR could impact referral rates. One of the studies evaluated the perceptions that physicians and CR programs had on various referral strategies. While more study is needed to assess the actual level of knowledge and awareness physicians have regarding CR, this review supports using educational interventions as well as targeting various aspects of the referral process for improving referral rates.

A qualitative study exploring factors that influence enrollment in outpatient cardiac rehabilitation

Purpose: This study explored patients’ decision-making about whether or not to enroll in cardiac rehabilitation (CR), an underutilized program that is associated with significantly improved health outcomes.Method: Face-to-face interviews were conducted with acute coronary syndrome patients (n = 14) after referral to a local CR center, but prior to program enrollment. Thematic analysis was used to derive themes from interview transcripts.Results: Three themes emerged including anticipated benefit, perceived ability, and contextual influences. Participants believed key benefits of CR would be access to specialist health care providers, improved longevity, reduced cardiovascular risk, as well as improved motivation, accountability, learning opportunities, and general fitness. Participants were concerned about their ability to engage in and travel to exercise sessions, pay the program fee, and manage scheduling conflicts. Contextual influences on decision-making included health care provider recommendation, first impressions of the CR center, knowledge gaps about what CR entails, input from family and peers, and psychological distress.Conclusion: The period following CR referral but prior to enrollment represents an optimal opportunity to promote in-the-moment decisions in favor of CR. Patients report both positive and negative aspects of CR, suggesting individualized efforts to resolve ambivalence may increase program participation.Implications for RehabilitationCardiovascular disease is a leading cause of mortality worldwide.Cardiac rehabilitation (CR) is an effective secondary prevention strategy to improve cardiovascular morbidity and mortality, but only a subset of eligible patients enroll.After referral but prior to enrollment, patients anticipate both positive and negative aspects of CR participation.Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase uptake into CR programs.

Point/Counterpoint

Point/Counterpoint

Communicating about sexual concerns within cardiac health services: Do service providers and service users agree?

ObjectiveSexual assessment and counselling is a recommended, yet underprovided and challenging, aspect of cardiac rehabilitation. We compared the views of cardiac healthcare providers and patients in terms of their experiences of communication about sexual issues. MethodsCardiac patients (n=382) completed telephone surveys and hospital cardiac rehabilitation staff (n=60) and general practitioners (n=61) returned postal questionnaires. ResultsPatients reported that sex was rarely discussed, yet nearly half of patients said they would have liked this opportunity. Most general practitioners (70%) reported not addressing sex with their patients and the majority of cardiac rehabilitators (almost 61%) reported that sexual problems were poorly addressed in their service. Patients perceived fewer barriers to communication (the main barrier was lack of privacy) than health professionals (the primary barrier for general practitioners was lack of time, and for cardiac rehabilitation staff, lack of training). ConclusionAll participants agreed that sexual assessment and counselling is currently poorly implemented. A gap exists: patients, who generally want sexual issues to be addressed, perceive fewer barriers to communication than healthcare providers, who fear causing anxiety and discomfort by raising sexual issues with their patients. Practice implicationsDeveloping brief interventions for healthcare providers and information materials for patients are recommended.

Preventive cardiology and cardiac rehabilitation

Cardiovascular disease is the leading cause of death in India. It has reached epidemic proportions, and needs to be addressed through primary and secondary prevention measures. The field of preventive...

Cardiovascular Rehabilitation in Patients With Diabetes

DEAR EDITOR-IN-CHIEF, W e read with great interest the article by Mourot et al 1 concerning cardiovascular rehabilitation in patients with diabetes. The prevalence of diabetes in patients with coronary artery disease (CAD) is known to be around 31% across Europe (Euro Heart Study) 2 ; thus, the evaluation of the physical performance of this group of patients after a period of cardiac rehabilitation (CR) is a stimulating topic and constitutes a daily issue in most CR units. Mourot et al have focused on 2 aspects of CR in this kind of patients: (1) a multidisciplinary approach (including education) is needed and it has to be tailored to the specific needs of the individual patient and (2) cardiorespiratory fitness is an independent predictor of long-term cardiac mortality in patients with diabetes and CAD and interventions to modify the exercise capacity are relevant, as they could have a positive prognostic impact. The great number of patients included in the study, the similarity of the 2 groups in terms of factors that influence exercise capacity and oxygen uptake (ie, age, sex, ejection fraction), and the accurate evaluation of the physical performance by cardiopulmonary exercise testing, the 6-minute walk test, and evaluation of hand strength make the conclusions of the study very significant. The authors demonstrate that in spite of a higher prevalence of risk factors and a lower initial performance, patients with CAD and diabetes can fully benefit from a multidisciplinary program of CR. However, we have concern about the methodology

Kardiale Rehabilitation in Deutschland

Cardiac rehabilitation in Germany is an important part of the healthcare system, especially for patients with coronary heart disease. The quality of care is one of the best worldwide and is well controlled by various instruments for external and internal quality management. The scientific guidelines for treating patients adequately are written and controlled in a registry by the German Society of Prevention and Rehabilitation of Cardiovascular Disease (DGPR e.V.). The results of various registries, studies and meta-analysis have demonstrated a clear and significant positive effect of cardiac rehabilitation on morbidity and mortality of patients suffering from coronary heart disease. A continuing challenge in cardiac rehabilitation is the development of new forms of rehabilitation to achieve the same positive effects in long-term treatment of cardiac patients as in acute treatment. In Germany, especially the preventive aspect of cardiac rehabilitation has to be accepted by the health insurance providers as a standard aim of cardiac rehabilitation and should receive more attention in the health care of cardiac patients in the future.

An Anthropological Perspective on Some Cultural Aspects of Cardiac Rehabilitation

An Anthropological Perspective on Some Cultural Aspects of Cardiac Rehabilitation

Psychological aspects of cardiac rehabilitation. Assessment and approach to the patient.

Psychological aspects of cardiac rehabilitation. Assessment and approach to the patient.