Factors Associated with Non-Completion of Cardiac Rehabilitation in Heart Failure Patients: “Medical” and “Non-Medical” Drop-Outs

Abstract Background There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences. Methods A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources. Results Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were ‘the organisation of healthcare system’, ‘the organisation of cardiac rehabilitation programmes’, ‘healthcare professional’ factors and ‘guidelines’. The most frequent themes included ‘lack of resources: time, staff, facilities and equipment’ and ‘professional’s knowledge, awareness and attitude’. Conclusions Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research.

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ECG telemonitoring during home-based cardiac rehabilitation in heart failure patients

Journal of Telemedicine and Telecare ◽

10.1258/jtt.2012.111005 ◽

2012 ◽

Vol 18 (4) ◽

pp. 193-197 ◽

Cited By ~ 25

Author(s):

Ewa Piotrowicz ◽

Anna Jasionowska ◽

Maria Banaszak-Bednarczyk ◽

Joanna Gwilkowska ◽

Ryszard Piotrowicz

Keyword(s):

Heart Failure ◽

Cardiac Rehabilitation ◽

Holter Ecg ◽

Heart Failure Patients ◽

Monitoring Centre ◽

Home Based ◽

Patients With Heart Failure ◽

Atrial Fibrillation Episode ◽

The Times ◽

Premature Beats

We assessed ECGs recorded during home-based telemonitored cardiac rehabilitation (HTCR) in stable patients with heart-failure. The study included 75 patients with heart failure (NYHA II, III), with a mean age of 56 years. They participated in an eight-week programme of home cardiac rehabilitation which was telemonitored with a device which recorded 16-s fragments of their ECG. These fragments were transmitted via mobile phone to a monitoring centre. The times of the automatic ECG recordings were pre-set and coordinated with the cardiac rehabilitation. Patients were able to make additional recordings when they felt unwell using a tele-event-Holter ECG facility. During the study, 5757 HTCR sessions were recorded and 11,534 transmitted ECG fragments were evaluated. Most ECGs originated from the automatic recordings. Singular supraventricular and ventricular premature beats and ventricular couplets were detected in 16%, 69% and 16% of patients, respectively. Twenty ECGs were recorded when patients felt unwell: non sustained ventricular tachycardia occurred in three patients and paroxysmal atrial fibrillation episode in two patients. Heart failure patients undergoing HTCR did not develop any arrhythmia which required a change of the procedure, confirming it was safe. Cardiac rehabilitation at home was improved by utilizing the tele-event-Holter ECG facility.

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