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STRATEGIES TO INCREASE CARDIAC REHABILITATION ENROLLMENT: A NARRATIVE REVIEW. Put your Title here. C Andraos, BSc 1 , R Britto, PT, PhD 2 N Suskin, MBChB 3 , & SL Grace, PhD 1,4. *.

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STRATEGIES TO INCREASE CARDIAC REHABILITATIONENROLLMENT: A NARRATIVE REVIEW

Put your Title here

C Andraos, BSc1, R Britto, PT, PhD2 N Suskin, MBChB3, & SL Grace, PhD1,4

*

1York University, 2Federal University of Minas Gerais, 3London Health Sciences & Western, 4University Health Network

**

Pre / Control

Post / Intervention

  • Discussion
  • The interventions were most-commonly systematic referral, and early outpatient education or CR contact
  • All RCTs were positive (from 45 to 77% enrollment)
  • Odds ratios ranged from 1.49 to 4.85.
  • It is time to implement these strategies on a broad scale
  • Limitations
  • Only publications written in the English language were included
  • Did not consider quality
  • Potential publication bias
  • Rationale
  • Cardiovascular disease is one of the leading causes of morbidity and mortality in North America.
  • Cardiac Rehabilitation (CR) programs aid patients with recovery after cardiac events and/or procedures, and reduce mortality.
  • Unfortunately, CR programs are grossly under-utilized.
  • The last Cochrane review (Davies, 2010) of uptake interventions summarized the literature to 2008. 3 successful strategies were identified.
  • Method
  • Design:
  • Narrative review
  • Procedure
  • A limited literature search of publications between June 2008 to March 2013 was completed.
  • The following databases were searched: PubMed, Scopus, ProQuest, CINAHL and Embase.
  • Inclusion Criteria:
  • Based on the Cochrane Review (Davies et al., 2010), except non-randomized studies were also included.
  • Primary Outcome:
  • Patient enrollment in CR
  • Results
  • Ten studies were included, of which 3 were RCTs.
  • There was one null study (Mazzini), and one null strategy (Grace), and no negative findings.

***

Figure. CR Enrollment Rates in Included Studies

***

Cossette, 2012 - RCT

Inpatient + Outpatient RN Education

Grace, 2011§

Systematic Referral + Liaison

Grace, 2012

Early Outpatient Education @ CR

Systematic Referral prep-approved

Intake Appointment Pre-Booked

Higgins, 2008

Combination of 6 Interventions

Mazzini, 2008

Systematic Referral – GWTG

Mueller, 2009 - RCT

Systematic Referral + Early Education

Pack, 2013 - RCT

Early CR Orientation

Parker, 2011

Systematic Referral + Early Education

Tiller, 2013†

Systematic Referral + Early Education

***

**

***

*

60

80

100

20

40

Enrollment (%)

Conclusions

CR discussions at the bedside, systematized referral (including pre-approval), and early outpatient contact significantly increased patient enrollment in CR, to often greater than 80%.

  • Objective
  • To qualitatively review the literature on interventions to increase CR enrollment, since the Cochrane analysis

Johnson, 2010

Nurse CR referral OR = 3.40, 95% CI:1.74-6.64***

† no inferential test performed;§ other strategies not shown, p<0.01

* p < 0.05; ** p < 0.01; *** p < 0.001