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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
An Integrative Review of Formal Functional Support in Cardiac Rehabilitation Among Patients With Coronary Artery
Shelmith Witherell1, Todd Ruppar2, Manju Daniel3
1Shelmith Witherell, DNP, AGACNP-BC, Ph.D. Nursing Science - Student, Department of Community, Systems, and Mental Health, College of Nursing, Rush University, Chicago, Illinois.
Insights
Formal functional support improves cardiac rehabilitation (CR) enrollment and participation for coronary artery disease patients. While not objectively measured, patients valued these programs for guidance and flexibility.
Area of Science:
- Cardiology
- Public Health
- Rehabilitation Medicine
Background:
- Ischemic heart disease is a leading cause of global mortality and disability.
- Recurrent events and mortality risk significantly increase post-initial coronary event.
- Cardiac rehabilitation (CR) is crucial for secondary prevention, yet less than 30% of eligible patients complete recommended sessions.
Purpose of the Study:
- To synthesize research on the link between formal functional social support and CR participation/completion in adults with coronary artery disease.
Main Methods:
- Integrative review of quantitative, qualitative, and mixed-methods studies from PubMed, Scopus, and CINAHL (inception to June 2023).
- Two independent reviewers screened studies; quality appraised using CASP and MMAT.
- Included 10 studies (6 quantitative, 2 qualitative, 2 mixed-methods).
Main Results:
- Formal support interventions were categorized as individual (one-on-one) or system-level (environmental modification).
- Seven studies focused on individual-level support, and three on environmental/systemic levels.
- Participants receiving support interventions showed increased enrollment and participation in CR.
Conclusions:
- Formal functional support's objective impact on CR completion was not measured in reviewed studies.
- However, participants reported high satisfaction with formal support programs.
- Key valued aspects included healthcare professional guidance and program flexibility.
Background:
Ischemic heart disease is a major cause of premature death and disability worldwide. The chances for a recurrent coronary event and mortality increase significantly after the first event. Cardiac rehabilitation (CR) is an effective secondary prevention measure in reducing morbidity and mortality after a coronary event. Despite these benefits, fewer than 30% of eligible patients with coronary artery disease complete the recommended number of CR sessions.
Objective:
In this integrative review, our aim was to synthesize research on the relationship between formal functional social support and CR participation and completion among adults with coronary artery disease.
Methods:
We searched PubMed, Scopus, and CINAHL databases from inception to June 2023. Quantitative, qualitative, and mixed-methods studies were included. Two independent reviewers screened titles, abstracts, and full-text reviews. The study quality was appraised using the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool.
Results:
An initial search yielded 629 studies; 9 were included, and 1 was added after a hand search. Of the 10 studies reviewed, 6 were quantitative (60%), whereas 20% were qualitative and 20% were mixed-methods studies. Two main types of formal support interventions emerged: (1) individual interventions delivered one-on-one; and (2) system-level interventions, which involved modifying the environment to better support participants. There were 7 studies in which support interventions were targeted at the individual level, while 3 were focused at the environmental/systemic level. Participants who received support interventions had increased enrollment and participation in CR programs.
Conclusions:
Formal functional support was not objectively measured in the studies reviewed. However, participants expressed satisfaction with formal functional support programs, valued guidance from healthcare professionals, and the flexibility offered by support programs.
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