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 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.

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.

scholarly journals Web-Based Cardiac Rehabilitation: A Co-Design Workshop

2021 ◽  
Author(s):  
Katie Nesbitt ◽  
Alline Beleigoli ◽  
Huiyun Du ◽  
Rosy Tirimacco ◽  
Robyn A. Clark
Keyword(s):  
Cardiac Rehabilitation ◽  
Smart Phone ◽  
Health Behavior Change ◽  
Rehabilitation Program ◽  
Patient Portal ◽  
Web Based ◽  
Rehabilitation Programs ◽  
Survey Results ◽  
Design Workshop ◽  
Common Barriers

Background: Only 20–40% of candidates actually attend cardiac rehabilitation programs in Australia, with attendance numbers remaining unchanged in the last 20 years. Common barriers to cardiac rehabilitation are geographical isolation, work responsibilities and transportation. Web-based cardiac rehabilitation can provide an alternative, patient centred, flexible delivery option. Objective: The objective of this study was to describe how patient-generated input, through a workshop on desired content and features, informs technology and implementation specifications for the patient portal of a cardiac rehabilitation website. Methods: UX Design theoretical framework, using a co-design workshop, with thematic analysis and a survey. Results: We recruited 7 participants and 1 cardiac rehabilitation coordinator. The median age of participants was 75.0 (IQR 74.0–78.0), 4 (57.1%) were male and all had completed a cardiac rehabilitation program. Most used a smart phone (5, 71.4%) and Facebook (6, 85.7%). Four themes were identified: input information, format of information, usability and support of health behavior change, informing the next iteration of the workshops and contribute to the cardiac rehabilitation patient website development.

scholarly journals Efficacy of cardiac rehabilitation with motion assistance from wearable cyborg hybrid assistive limb in patients with chronic heart failure: a randomized controlled trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Watanabe ◽  
A Koike ◽  
H Kato ◽  
L Wu ◽  
K Hayashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Rehabilitation ◽  
Exercise Therapy ◽  
Knee Extensor ◽  
Control Group ◽  
Cardiac Events ◽  
Rehabilitation Programs ◽  
Sit To Stand ◽  
Knee Extensor Strength

Abstract Background Recent Cochrane Systematic Review suggested that the participation in cardiac rehabilitation is associated with approximately 20% lower cardiovascular mortality and morbidity. Exercise therapy is the key component of cardiac rehabilitation programs. In recent years, innovative technologies have been introduced into the field of rehabilitation, and a typical example is the wearable cyborg Hybrid Assistive Limb (HAL). The wearable cyborg HAL provides motion assistance based on detection of bioelectrical signals on the skin surface when muscle forces are generated. The lumbar-type HAL is expected to expand the therapeutic options for severe cardiac patients who have difficulty in performing usual cardiac rehabilitation programs, such as bicycle pedaling or walking. Purpose We aim to compare the efficacy of exercise therapy performed with motion assistance from a lumbar-type HAL versus conventional training (sit-to-stand exercise without HAL) in patients with chronic heart failure. Methods This clinical trial is a randomized, non-blinded, and controlled study. Twenty-eight heart failure patients (73.1±13.8 years) who have difficulty in walking at the usual walking speed of healthy subjects were randomly assigned to 2 groups (HAL group or control group) with a 1:1 allocation ratio and performed sit-to stand exercise either with HAL or without HAL for 5 to 30 minutes once a day, and 6 to 10 days during the study period. The brain natriuretic peptide (BNP), isometric knee extensor strength, standing ability (30-seconds chair-stand test: CS-30), short physical performance battery (SPPB) and 6-minute walking distance (6MWD) were measured before and after the completion of cardiac rehabilitation. Cardiac events such as death, re-hospitalization, myocardial infarction and worsening of angina pectoris and heart failure during 1 year after discharge were evaluated. Results There was no significant difference in the number of days of exercise therapy between the two groups. BNP, SPPB and 6MWD were improved in both groups. In the HAL group, the isometric knee extensor strength (0.29±0.11 vs 0.35±0.11 kgf/kg, p=0.003) significantly improved and CS-30 (5.5±5.1 vs 8.2±5.3, p=0.054) tended to improve. However, in the control group, either the isometric knee extensor strength (0.35±0.11 vs 0.36±0.14 kgf/kg, p=0.424) or CS-30 (6.0±4.3 vs 9.2±6.2, p=0.075) did not significantly change. HAL group showed significantly more improvement in the isometric knee extensor strength than control group (p=0.045). Cardiac events occurred in 20% in the HAL group and 43% in the control group. Conclusion The improvement in isometric knee extensor strength with the assistance from lumbar-type HAL suggests that exercise therapy using this device may be useful in chronic heart failure patients with flail or sarcopenia, a strong poor prognostic factor in these patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported in part by a grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (JSPS KAKENHI grant number JP17K09485) and funded by the ImPACT Program of the Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) (grant number 2017-PM05-03-01).

scholarly journals How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046051
Author(s):  
Alasdair F O'Doherty ◽  
Helen Humphreys ◽  
Susan Dawkes ◽  
Aynsley Cowie ◽  
Sally Hinton ◽  
...  
Keyword(s):  
High Risk ◽  
Cardiac Rehabilitation ◽  
Technology Use ◽  
Healthcare Professionals ◽  
Hospital Admissions ◽  
Well Being ◽  
Rehabilitation Service ◽  
High Risk Patients ◽  
Home Based ◽  
Risk Patients

ObjectiveTo investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.DesignA mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.SettingInternational survey of exercise-based cardiac rehabilitation programmes.ParticipantsHealthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.Main outcome measuresThe proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.ResultsThree hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.ConclusionsThe rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.

MO548PREVALENCE AND INCIDENCE OF ANAEMIA IN PATIENTS WITH NON-DIALYSIS DEPENDENT (NDD) CHRONIC KIDNEY DISEASE (CKD), AND EVALUATION OF TREATMENT PATTERNS WITH ERYTHROPOIESIS-STIMULATING AGENTS (ESAS): A RETROSPECTIVE DATABASE STUDY IN ITALY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Paolo Di Rienzo ◽  
Robert Snijder ◽  
Luca Degli Esposti ◽  
Valentina Perrone ◽  
Lora Todorova
Keyword(s):  
Census Data ◽  
First Record ◽  
Adverse Outcomes ◽  
Local Health ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Ckd Stage ◽  
Kdigo Guidelines ◽  
Patient’S History ◽  
Retrospective Database

Abstract Background and Aims Anaemia is a common complication in patients with NDD-CKD, and its prevalence increases with advancing CKD stage.1,2 It is a risk factor for both CKD progression and other adverse outcomes, including major adverse cardiac events, hospitalisation and all-cause mortality.1 We aim to report the prevalence of NDD-CKD stage 3a–5 in Italy, and to evaluate the prevalence and incidence of anaemia among patients with NDD-CKD. Of those patients with anaemia, we seek to establish the size of the patient pool eligible for ESAs, and consequently, the proportion of patients treated with ESAs. Method Patients ≥18 years of age with a record of NDD-CKD stage 3a–5 between 1 January 2014 and 31 December 2016 were identified from databases of five Local Health Units (LHUs) across Italy. NDD-CKD stage 3a–5 in our study was defined as either ≥1 hospitalisation record with discharge diagnosis of CKD (ICD-9-CM 585.x, where x = 3, 4, or 5) or ≥1 record of estimated glomerular filtration rate (eGFR) <60 mL/min. eGFR values were estimated using the Modification of Diet in Renal Disease method and were as reported by LHUs. Patient classification into CKD stage 3a–5 based on eGFR was done according to KDIGO guidelines.3 Anaemia was defined as Hb <13 g/dL (males) or <12 g/dL (females). Prevalence was defined as the presence of ≥1 record of NDD-CKD stage 3a–5 or anaemia in the entire period preceding the timepoint of interest, or as incident NDD-CKD/anaemia; incidence was defined as a first record of the condition in the year of interest (no record of the condition in the patient’s history). Point prevalence (at 31 December of each reported year) and annual incidence were age- and sex-standardised using census data from 1 January of the following year. Among patients with anaemia of NDD-CKD stage 3a–5, eligibility for ESA was defined as at least one record of Hb <10 g/dL,4 and patients with a record of ESA prescription were categorised as ESA treated. Results For 2016, the prevalence of NDD-CKD stage 3a–5 in the population aged ≥18 years was 5.6% (83,625/1,507,391): CKD stage 3a was the most common (4.2%; 62,683/1,507,391), while the prevalence of each of the stages 3b–5 was ≤1.0% (Table). The prevalence and incidence of anaemia among patients with NDD-CKD stage 3a–5 in 2016 was 33.8% and 11.4%, respectively. The prevalence of anaemia increased with CKD stage: from 28.2% among patients with stage 3a to 78.9% among those with stage 5. A similar trend was observed for incidence, which increased from 9.3% for stage 3a to 32.8% for stage 5. The proportion of patients with NDD-CKD stage 3a–5 and anaemia who were eligible for ESA treatment from 2014–2016 ranged from 51.9% to 75.6% across the CKD stages. In 2016, the proportion of patients with incident NDD-CKD anaemia who were eligible for ESAs but not treated was 42.3%. This proportion was similar across the CKD stages, except for stage 5, for which the proportion of patients who were eligible but not ESA treated was 51.1%. Conclusion In Italy, we found that higher CKD stages are associated with increased prevalence and incidence of anaemia in NDD-CKD, a finding which is supported by previous research in other countries worldwide.1,2 Despite this, almost half of patients with anaemia of NDD-CKD stage 3a–5 were eligible for ESA treatment but did not receive ESAs. This suggests that anaemia may not be adequately controlled in patients with NDD-CKD stage 3a–5, and may need further attention and treatment.

scholarly journals ‘I was in control of it from the start’: A qualitative study of men’s experiences of positive adjustment following a heart attack

2016 ◽  
Vol 22 (10) ◽  
pp. 1345-1354
Author(s):  
Fran Smith ◽  
Elizabeth Banwell ◽  
Roby Rakhit
Keyword(s):  
Qualitative Study ◽  
Cardiac Rehabilitation ◽  
Coping Strategies ◽  
Heart Attack ◽  
Adaptive Coping ◽  
Structured Interviews ◽  
Cardiac Rehabilitation Programme ◽  
Positive Adjustment ◽  
Interpersonal Factors ◽  
Controllable Factors

A qualitative design was used to explore the experience of positive adjustment following a heart attack. Ten men attending a cardiac rehabilitation programme completed in-depth semi-structured interviews. An overarching theme: ‘I was in control of it from the start’ emerged with six subthemes, relating to intrapersonal and interpersonal factors and processes. The subthemes reflected the importance of identifying controllable versus non-controllable factors and employing adaptive coping strategies.

scholarly journals Multimorbidity and Hospital Admissions in High-Need, High-Cost Elderly Patients

2018 ◽  
Vol 32 (5-6) ◽  
pp. 259-268 ◽  
Author(s):  
Alessandra Buja ◽  
Michele Rivera ◽  
Elisa De Battisti ◽  
Maria Chiara Corti ◽  
Francesco Avossa ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Strong Association ◽  
Local Health ◽  
Care Needs ◽  
Local Health Unit ◽  
Hospitalization Rates ◽  
Exposure Variable ◽  
Hospital Discharge Records ◽  
Adjusted Clinical Groups

Objective: The aim was to clarify which pairs or clusters of diseases predict the hospital-related events and death in a population of patients with complex health care needs (PCHCN). Method: Subjects classified in 2012 as PCHCN in a local health unit by ACG® (Adjusted Clinical Groups) System were linked with hospital discharge records in 2013 to identify those who experienced any of a series of hospital admission events and death. Number of comorbidities, comorbidities dyads, and latent classes were used as exposure variable. Regression analyses were applied to examine the associations between dependent and exposure variables. Results: Besides the fact that larger number of chronic conditions is associated with higher odds of hospital admission or death, we showed that certain dyads and classes of diseases have a particularly strong association with these outcomes. Discussion: Unlike morbidity counts, analyzing morbidity clusters and dyads reveals which combinations of morbidities are associated with the highest hospitalization rates or death.

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