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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
A controlled intervention to increase participation in cardiac rehabilitation
Rachel Dankner1, Yaakov Drory2, Galit Geulayov3
1Unit for Cardiovascular Epidemiology, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel Division of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel RachelD@gertner.health.gov.il.
Insights
A low-cost intervention nearly doubled participation in cardiac rehabilitation programs for coronary artery bypass graft patients. This strategy effectively reached underrepresented groups, addressing knowledge gaps to improve access to vital post-surgery care.
Area of Science:
- Cardiovascular Medicine
- Public Health Interventions
- Health Services Research
Background:
- Cardiac rehabilitation programs are significantly underutilized in patient care.
- Underutilization disproportionately affects specific demographic and socioeconomic groups.
- Lack of patient knowledge is a primary barrier to cardiac rehabilitation participation.
Purpose of the Study:
- To evaluate the effectiveness of a low-cost intervention to increase cardiac rehabilitation participation.
- To assess the impact of the intervention on underrepresented patient subpopulations.
- To identify factors associated with participation in cardiac rehabilitation post-coronary artery bypass graft surgery.
Main Methods:
- A multicenter, interventional, controlled cohort study involving 1024 coronary artery bypass graft (CABG) patients.
- Intervention group received enhanced education on cardiac rehabilitation benefits and a follow-up call.
- Data collected via pre-surgery interviews and 1-year post-discharge follow-ups.
Main Results:
- Cardiac rehabilitation participation increased from 16.5% in the control arm to 31.0% in the intervention arm (p < 0.001).
- Key factors for participation included intervention arm, male sex, higher income, pre-surgery physical activity, younger age, and BMI > 30 kg/m².
- Significant participation increases were noted in patients with limited education and lower income.
Conclusions:
- A simple, low-cost intervention effectively doubled cardiac rehabilitation participation rates.
- The intervention demonstrated particular success in engaging previously underrepresented patient groups.
- Addressing knowledge deficits is crucial for improving access to cardiac rehabilitation.
Background:
Cardiac rehabilitation programs are greatly underutilized.
Design:
This study was a multicenter interventional controlled cohort study.
Methods:
From cardiothoracic departments of five medical centers, 520 coronary artery bypass graft (CABG) patients (386 men) were enrolled in the control arm and 504 CABG patients (394 men) in the intervention arm of our study. A 1-hour seminar to medical staff on the benefits of cardiac rehabilitation followed the control phase and preceded the intervention phase. Patients in the intervention arm received written and oral explanations on cardiac rehabilitation benefits and eligibility, and a follow-up telephone call 2 weeks after hospital discharge. Patients in both study arms were interviewed in the hospital prior to CABG surgery and in their homes a year later.
Results:
Rates of participation in cardiac rehabilitation were 16.5% (86/520) for the control arm and 31.0% (156/504) for the intervention arm (p < 0.001). Factors strongly associated with participation in cardiac rehabilitation were: belonging to the intervention arm (OR: 2.06 95% CI: 1.46-2.90, p < 0.0001), male sex, average or above average income, sports related physical activity before surgery, younger age and BMI > 30 kg/m(2). Particularly high increases in participation rates following the implementation were observed among subpopulations of 10 years or less education and those reporting below average income. "Lack of knowledge" regarding cardiac rehabilitation was the reason most commonly stated for not participating in a cardiac rehabilitation program.
Conclusion:
Participation in cardiac rehabilitation almost doubled following a low cost intervention with significant effects on subpopulations that have been underrepresented in cardiac rehabilitation programs.
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