How the COVID pandemic affected utilisation of cardiac rehabilitation in rural Australia?

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
A Beleigoli ◽  
S Champion ◽  
R Tirimacco ◽  
K Govin ◽  
P Tideman ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
South Australia ◽  
Adverse Outcomes ◽  
Public Institution ◽  
World Health ◽  
Economic Disadvantage ◽  
Local Health ◽  
Service Access ◽  
Rural And Remote ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Caring Futures Institute Background Provision of cardiac rehabilitation (CR) was disrupted in 31% of the 155 countries according to the World Health Organisation during the early months of the COVID pandemic. This might have been associated with worsening clinical outcomes and is of particular concern to patients living in rural and remote areas. In Australia, these patients have a higher prevalence of cardiovascular diseases, higher rates of adverse outcomes due to acute myocardial infarction and limited availability to regional services. Purpose We aimed to investigate how the COVID affected the delivery of CR services in rural and remote South Australia (SA) during the first wave of the COVID pandemic.  Methods CR attendance, completion and waiting times in the pre-COVID period (February-July 2019) was compared to data during the first wave of COVID (February-July 2020) using data from CR services across six regional local health networks recorded in the Country Access to Cardiac Health (CATCH) database. Results There were 922 patients (32.2% females; mean age 69.2 years; 36.6% living in areas with high socio-economic disadvantage) referred to CR in the pre-COVID period, and 1032 patients (30.7% females; mean age 68.1 years; 35.7% living in areas with high socio-economic disadvantage) in the COVID period across the six regional areas in South Australia. Acute coronary syndrome was the main reason for referral both pre (251; 27.2%) and during COVID (273; 26.5%). The proportion of CR attendance was higher in the pre (522; 56.6%) compared to the COVID period (431, 41.8%; p < 0.001).  Completion was higher pre (413, 79.1%) compared to during COVID period (205,47.6%) completed CR during the COVID period (p < 0.001). The waiting time was 35 (SD 27) days pre-COVID and 34 (SD 25) days in the COVID period (p = 0.37). Conclusion Our data show that attendance and completion of CR programs were significantly reduced during the COVID period in rural and remote Australia. Limited service access during the pandemic and fear to physically attend health services during the period of social and physical restrictions might have contributed to this. Telehealth-delivered CR can provide opportunities to continuity of cardiovascular care and secondary prevention during pandemic restrictions.

Abstract 16044: Association of Area Deprivation Index With Recurrent Cardiovascular Outcomes: Does Cardiac Rehabilitation Participation Mitigate Effects?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emily N Guhl ◽  
Jianhui Zhu ◽  
Amber Johnson ◽  
Utibe Essien ◽  
Floyd W Thoma ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Coronary Intervention ◽  
Primary Diagnosis ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Coronary Syndrome ◽  
Regional Center ◽  
Health Promoting

Introduction: Neighborhood location impacts access to health-promoting resources and outcomes. Cardiac rehabilitation (CR) provides a multidisciplinary approach that improves cardiovascular outcomes. We evaluated the association of Area Deprivation Index (ADI) and cardiovascular events in individuals with incident Heart Failure (HF) or myocardial infarction (MI) and the modifying effect of CR. Methods: We identified an observational cohort admitted with primary diagnosis of 1) MI with percutaneous coronary intervention or 2) a primary diagnosis of incident HF from 2010-2018 at a multi-site regional center. We derived ADI from patient home address and then categorized into quartiles. Demographics, clinical covariates, and CR participation post-hospitalization were obtained from the electronic medical record. We compared rates of readmission for a cardiovascular primary diagnosis and mortality across ADI quartiles. Analyses were then stratified by CR participation. Results: In a cohort of 6957 (38.2% women, 88.7% white) with adjustment for covariates, increasing ADI was significantly associated with higher rates of cardiovascular rehospitalization (p<0.01), Acute Coronary Syndrome (ACS) rehospitalization (p=0.01), HF rehospitalization (p<0.01), and all-cause mortality (p=0.04), Table. When we stratified across CR participation, those with participation had significantly lower rehospitalizations (p<0.01) and mortality (p<0.01) when compared to the no CR group. There was no significant effect of ADI on outcomes in the CR group. Discussion: We found increased ADI was adversely associated with mortality and rehospitalizations in cardiac patients. For those participating in CR, there was 1) no significant effect of ADI and 2) decreased incidence of adverse outcomes vs. those who did not participate in CR. Given the benefit of CR participation on ADI’s adverse effect on outcomes, future interventions should focus on increasing CR participation.

scholarly journals A co-designed telehealth-based model of care to improve attendance and completion to cardiac rehabilitation of rural and remote Australians: The Country Heart Attack Prevention (CHAP) project

2021 ◽  
Vol 27 (10) ◽  
pp. 685-690
Author(s):  
Alline Beleigoli ◽  
Stephanie Champion ◽  
Rosy Tirimacco ◽  
Katie Nesbitt ◽  
Philip Tideman ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Mode Of Delivery ◽  
Local Context ◽  
Local Health ◽  
Model Of Care ◽  
Rural And Remote ◽  
Cardiac Rehabilitation Programme ◽  
Web Based ◽  
Patient Reported ◽  
The Impact

We aim to report the co-design of the implementation strategy of a telehealth-enabled cardiac rehabilitation model of care in rural and remote areas of Australia. The goal of this model of care is to increase cardiac rehabilitation attendance and completion by country patients with cardiovascular diseases. We hypothesise that a model of care co-designed with stakeholders will address patients’ needs and preferences and increase participation. We applied the Model for Large Scale Knowledge Translation and engaged with patients, clinicians and health service managers across six local health networks in rural South Australia. They informed the design of a web-based cardiac rehabilitation programme and the delivery of the expanded telehealth service. The stakeholders defined face-to-face, telephone, web-based or combinations as choices of mode of delivery to patients referred to cardiac rehabilitation. A case-managed programme supported by a web portal with an interface for patients and clinicians was considered more appropriate to the local context than a self-managed programme. A business model was developed to enable the sustainability of cardiac rehabilitation clinical assessments through primary care. The impact of the model of care on cardiac rehabilitation attendance/completion, clinical outcomes, patient-reported outcomes and patient-reported experiences and cost-effectiveness will be tested in a 12-month follow-up study.

scholarly journals Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

2019 ◽  
Vol 16 (24) ◽  
pp. 5126 ◽  
Author(s):  
Sandra C. Thompson ◽  
Lee Nedkoff ◽  
Judith Katzenellenbogen ◽  
Mohammad Akhtar Hussain ◽  
Frank Sanfilippo
Keyword(s):  
Cardiac Rehabilitation ◽  
Rural Areas ◽  
New Technologies ◽  
Relevant Literature ◽  
Diagnostic Testing ◽  
Narrative Review ◽  
Rural And Remote ◽  
Coronary Syndrome ◽  
Follow Up Care

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.

scholarly journals Co-designing digital cardiac rehabilitation with patients living in rural and remote australia - the country heart attack prevention project

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
KATIE Nesbitt ◽  
A Beleigoli ◽  
H Du ◽  
RA Clark ◽  
R Tirimacco
Keyword(s):  
Cardiac Rehabilitation ◽  
Heart Attack ◽  
Hospital Admissions ◽  
Local Health ◽  
Patient Portal ◽  
Rural And Remote ◽  
Cardiac Events ◽  
Web Based ◽  
System Usability Scale ◽  
Prevention Project

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Co-sponsored National health Medical Partnership Grant OnBehalf the country heart attack prevention project Background/significance. Cardiac rehabilitation (CR) significantly reduces death, reoccurring cardiac events, hospital admissions while improving quality of life. However, it is still poorly attended with participation rates worldwide between 20-50%, worsened for rural and remote patients by the tyranny of distance, work responsibilities and transportation. Web-based CR can provide an alternative, patient centred, flexible delivery option. Co-design with consumers and clinicians is recommended to tailor web-based CR to their needs and preferences as a means of increasing attendance. Purpose. The objective of this study is to describe how patient-generated data through workshops on desired content and features informs technology and implementation specifications for the patient portal of a CR website. Methods. UX Design theoretical framework, using a co-design workshop, with thematic analysis, a survey, and the System Usability Scale was used to report outcomes. Results. Based on the feedback from participants in rural and remote SA, desired content and features were updated for improving user experience. We recruited 27 participants across 4 regional Local health Networks in SA. The median age of participants was 71.0 (IQR 58-78), 14 (51.9%) were female and 27 (100%) had completed a cardiac rehabilitation program. More than half used a smart phone (16; 59.3%) and Facebook (21; 77.8%). Overall usability remains low based on a mean SUS score of 63.4 (SD 21.1), however there was a tendency to usability improving over time. Conclusion. The co-design process has contributed to the development of the CR website, improving desired content and features. Improved usability scores can be achieved through further incorporating consumer feedback into the development of the CR website.

scholarly journals Partnerships in Health Development

2021 ◽  
Vol 23 (1) ◽  
pp. 143-154
Author(s):  
Palitha Abeykoon
Keyword(s):  
Technical Assistance ◽  
Communicable Disease ◽  
Moral Rights ◽  
World Health ◽  
Service Access ◽  
Health Coverage ◽  
Health Development ◽  
The Sustainable Development ◽  
Provision Of Services ◽  
Health Organization

The COVID-19 pandemic has thrown into bold relief the need for an all-of-society response supported by regional and global partnerships to control the epidemic. Addressing the social determinants of health, Universal Health Coverage, the non-communicable disease (NCD) burden, the other communicable diseases and the achievement of the Sustainable Development Goals (SDGs) all would require a close collaboration among different sectors and stakeholders, including the private sector. Partnerships connote three fundamental themes—a relative equality between the partners, mutual commitment to agreed objectives and mutual benefit for the stakeholders involved. The decisions are made jointly, and roles are not only respected but are also backed by legal and moral rights. The World Health Organization (WHO) has been and continues to be the foremost promoter as well as the host for many of the global and regional partnerships in health. A typological classification would include technical assistance partnerships supporting service access and provision of services including drugs, partnerships focusing on research and development, advocacy and resource mobilisation and financing partnerships mainly to provide funds for definite disease programmes. Partnerships in health have brought and continue to bring multiple benefits to the countries. But they also engender several challenges, including the duplication of effort and waste, high transaction costs (usually to government), issues of accountability and consequent lack of alignment with country priorities. As partnerships become increasingly significant in the twenty-first century, better coordination, particularly in terms of donor harmonisation with national priorities, would be needed. It is not ambitious to attempt the elusive ideal where all parties will benefit from one other with a give and take between all stakeholders. Partnerships in health could well herald a new dawn for health development in the South-East Asia Region.

Rationale and design of remotely-supervised cardiac rehabilitation study in patients with obstructive sleep apnea

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Hnatiak ◽  
O Ludka ◽  
L Batalik ◽  
P Winnige ◽  
F Dosbaba
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Rehabilitation ◽  
Public Institution ◽  
Moderate Intensity ◽  
Newly Diagnosed ◽  
Cpap Therapy ◽  
Phone Calls ◽  
Obstructive Sleep ◽  
Home Conditions

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Health Czech Republic; identification of organization 65269705 Background Although continuous positive airway pressure (CPAP) is currently still the gold standard for therapy of moderate to severe obstructive sleep apnea (OSA), another alternative or adjunct effective therapeutic options exist. Lifestyle intervention focused on nutrition and weight reduction, regular exercise, sleep hygiene, smoking and alcohol restriction represents a recommended therapeutic strategy for OSA. Though this intervention represents an effective tool for improving objective and subjective parameters of OSA, it’s effectivity depends on components of the intervention, OSA severity and gender. Comprehensive remotely-supervised cardiac rehabilitation (CR) represents possible training intervention in home conditions using elements of telemedicine. Purpose This prospective study aims to investigate the feasibility and effect of a remotely-supervised CR in patients with newly diagnosed OSA with Apnea-Hypopnea Index greater than 15 episodes per hour. Methods This monocentric study is designed as a prospective, parallel, randomised, controlled trial of remotely-supervised 12-week CR in male patients between 40-60 years old with newly diagnosed OSA indicated to CPAP therapy. The sample size is calculated by 0,05 level of significance and 80% statistical power on 25 participants in each group. The Intervention group will undergo comprehensive remotely-supervised CR in home conditions with teleconsultation (contains telecoaching, telemonitoring) via regular phone calls and e-mails at least 1-2 times a week. The intervention will include nutrition, health-related lifestyle and behavioral changes recommendations, and at least 5 times a week 30 minutes of moderate-intensity aerobic training, 10 minutes of inspiratory and expiratory muscle training with breathing device and 10 minutes of oropharyngeal exercise along with individually titrated CPAP therapy. The control group will undergo individually titrated CPAP therapy only. The participants in both groups will go through the following assessments before and after this study: polysomnography, spirometry, anthropometry and body composition examination, laboratory values examination, quality of life questionnaires, Epworth sleepiness scale, 6-min walking test. Conclusions: Comprehensive remotely-supervised CR, as mentioned in this study, may represent an adjunct therapy with a promising future in patients with OSA. The study is occupied with a current issue and can also bring new possibilities and experiences in remote rehabilitation.

scholarly journals Relationships between Psychoeducational Rehabilitation and Health Outcomes—A Systematic Review Focused on Acute Coronary Syndrome

2021 ◽  
Vol 11 (6) ◽  
pp. 440
Author(s):  
Sabina Alexandra Cojocariu ◽  
Alexandra Maștaleru ◽  
Radu Andy Sascău ◽  
Cristian Stătescu ◽  
Florin Mitu ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Psychological Intervention ◽  
Nyha Class ◽  
Illness Perception ◽  
Rehabilitation Program ◽  
Psychoeducational Intervention ◽  
Current Evidence ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome

(1) Background: Cardiac rehabilitation is a multidisciplinary program that includes psychoeducational support in addition to physical exercise. Psychoeducational intervention is a component that has had accelerated interest and development in recent decades. The aim was to analyze the current evidence on the effectiveness of psychoeducational interventions for patients with acute coronary syndrome (ACS). (2) Methods: We conducted a systematic search of the literature via four databases: PubMed, CENTRAL, PsycINFO, and EMBASE. We included randomized controlled trials that evaluated the effectiveness of a psychoeducational intervention compared to usual care in ACS patients. We assessed the risk of bias using a modified version of the Cochrane tool. We analyzed data regarding the population, intervention, comparator, outcomes, and timing. (3) Results: We identified 6248 studies. After a rigorous screening, we included in the analysis 11 articles with a total of 3090 participants. Major adverse cardiovascular events, quality of life, hospitalizations, lipidogram, creatinine, NYHA class, smoking, physical behavior, and emotional state were significantly improved. In addition, illness perception, knowledge, and beliefs were substantially ameliorated (all p < 0.001). All this was related to the type and dose of psychological intervention. (4) Conclusions: Patients with ACS can receive significant benefits through individualized psychoeducation sessions. The cardiac rehabilitation program should include personalized psychological and educational intervention by type and dose.

scholarly journals Risk and the Republican National Convention: Application of the Novel COVID-19 Operational Risk Assessment

2021 ◽  
pp. 1-6
Author(s):  
David Callaway ◽  
Jeff Runge ◽  
Lucia Mullen ◽  
Lisa Rentz ◽  
Kevin Staley ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
Care Delivery ◽  
The United States ◽  
Lessons Learned ◽  
World Health ◽  
Local Health ◽  
Mass Gathering ◽  
Wide Range ◽  
National Convention

Abstract The United States Centers for Disease Control and Prevention and the World Health Organization broadly categorize mass gathering events as high risk for amplification of coronavirus disease 2019 (COVID-19) spread in a community due to the nature of respiratory diseases and the transmission dynamics. However, various measures and modifications can be put in place to limit or reduce the risk of further spread of COVID-19 for the mass gathering. During this pandemic, the Johns Hopkins University Center for Health Security produced a risk assessment and mitigation tool for decision-makers to assess SARS-CoV-2 transmission risks that may arise as organizations and businesses hold mass gatherings or increase business operations: The JHU Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19 (Toolkit). This article describes the deployment of a data-informed, risk-reduction strategy that protects local communities, preserves local health-care capacity, and supports democratic processes through the safe execution of the Republican National Convention in Charlotte, North Carolina. The successful use of the Toolkit and the lessons learned from this experience are applicable in a wide range of public health settings, including school reopening, expansion of public services, and even resumption of health-care delivery.

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