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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Promoting Patient Utilization of Outpatient Cardiac Rehabilitation: A JOINT INTERNATIONAL COUNCIL AND CANADIAN
Carolina Santiago de Araújo Pio1, Theresa M Beckie, Marlien Varnfield
1School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada (Ms Santiago de Araújo Pio and Dr Grace); College of Nursing, University of South Florida, Tampa (Dr Beckie); The Australian eHealth Research Centre, CSIRO, Floreat, Australia (Dr Varnfield); Australian Cardiovascular Health and Rehabilitation Association (ACRA), New South Wales, Australia (Dr Varnfield); Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada (Dr Sarrafzadegan); Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran (Dr Sarrafzadegan); Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India (Dr Babu); Department of Physiotherapy, Kathmandu University, Dhulikhel Hospital, Dhulikhel, Nepal (Ms Baidya); University Centre Shrewsbury, Shrewsbury, England (Dr Buckley); Department of Physical Medicine & Rehabilitation, Fu Jen Catholic University Hospital and College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (Dr Chen); Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (Dr Chen); Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada (Dr Gagliardi); Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa (Dr Heine); Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam (Mr Khiong); Care Transitions and Population Health Management, New York University Langone Health Medical Center, New York City (Dr Mola); National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia (Dr Radi); Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain (Dr Supervia); Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Dr Supervia); Philippine Heart Association, Pasig City, Philippines (Dr Trani); Cardiology Department, Hospital Santa Maria, CHLN, Lisbon, Portugal (Dr Abreu); Medical School of University of Lisbon, Lisbon, Portugal (Dr Abreu); Public Education and Special Projects, Cardiac Health Foundation of Canada, Toronto, Ontario, Canada (Mr Sawdon); Patient Partner Program, University Health Network, Toronto, Canada (Mr Moffatt); and Toronto Rehabilitation Institute, KITE-University Health Network, University of Toronto, Canada (Dr Grace).
Purpose:
Cardiac rehabilitation (CR) is a recommendation in international clinical practice guidelines given its benefits; however, use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrollment and adherence into implementable recommendations.
Methods:
The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patients' utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A Web call was convened to achieve consensus and confirm strength of the recommendations (based on Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review and public comment.
Results:
The 3 drafted recommendations were that to increase enrollment, health care providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence, part of CR could be delivered remotely (weak). Ratings (mean ± SD) for the 3 recommendations were 5.95 ± 0.69, 5.33 ± 1.12, and 5.64 ± 1.08, respectively.
Conclusions:
Interventions can significantly increase utilization of CR and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization and to ensure that CR programs are adequately resourced to serve enrolling patients and support them to complete programs.
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