Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland

Abstract Background and purpose The majority of patients with heart failure (HF) have difficulties in independently carrying out activities of daily living and hence, require support from caregivers (CGs). This study assessed the quality of life (QoL) of CGs of HF patients with sub-normal LVEF (≤60%). Methods A cross-sectional survey of HF patients and their CGs was conducted in France, Germany, Italy, Spain and the UK. Cardiologists and primary care physicians completed patient record forms (PRF) between June and November 2019. Caregivers of the same patients were invited to complete a caregiver self-completion survey, which included the Family Caregiver QoL Scale (FAMQOL) and EQ-5D. Patient demographics were derived from PRFs. Results 361 CGs (73.1% female, mean age: 58.8 yrs) and HF patients (39.9% female, mean age: 71.2 yrs) were included. 58.2% of the CGs were spouses, 23.4% a child of the patient. On average, CGs devoted 20 hrs/week in the care of HF patients; this CG time increased from 12 to 26 hrs/week with NYHA class I to III/IV of the HF patient. Further, anxiety/stress was experienced overall by 29/31% of CGs which increased from 27/17% for NYHA I to 40/41% for NYHA III/IV of the HF patient (Table 1). Conclusions Caregivers of patients with HF and LVEF ≤60% spend a significant amount of time to provide daily support to HF patients. Patients with progressive disease were older, more polymorbid and had a higher disease duration. These factors likely contributed towards increased caregiver burden of HF patients with increased NYHA class. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG

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Health literacy among caregivers of patients with heart failure: A multicentre cross‐sectional survey

Journal of Clinical Nursing ◽

10.1111/jocn.14137 ◽

2017 ◽

Vol 27 (3-4) ◽

pp. 859-865 ◽

Cited By ~ 3

Author(s):

Carlo Della Pelle ◽

Vincenzo Orsatti ◽

Francesco Cipollone ◽

Giancarlo Cicolini

Keyword(s):

Heart Failure ◽

Health Literacy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patients With Heart Failure

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Care pathways and treatment patterns for patients with heart failure in China: results from a cross-sectional survey

Drug Design Development and Therapy ◽

10.2147/dddt.s166277 ◽

2018 ◽

Vol Volume 12 ◽

pp. 2311-2321 ◽

Cited By ~ 1

Author(s):

James DS Jackson ◽

Sarah E Cotton ◽

Sara Bruce Wirta ◽

Catia C Proenca ◽

Milun Zhang ◽

...

Keyword(s):

Heart Failure ◽

Treatment Patterns ◽

Care Pathways ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patients With Heart Failure

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Characterizing the role of, and physical and emotional burden on caregivers of patients with heart failure: Results from a cross-sectional survey in Japan

Geriatric Nursing ◽

10.1016/j.gerinurse.2021.01.010 ◽

2021 ◽

Vol 42 (2) ◽

pp. 379-385

Author(s):

Erika Hayashi ◽

Hironobu Mitani ◽

Hiroki Murayama ◽

Toshihisa Anzai ◽

Rachel Studer ◽

...

Keyword(s):

Heart Failure ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Emotional Burden ◽

Patients With Heart Failure

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Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals

BMC Health Services Research ◽

10.1186/s12913-016-1609-x ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 14

Author(s):

Jeanette Ziehm ◽

Erik Farin ◽

Jonas Schäfer ◽

Kathrin Woitha ◽

Gerhild Becker ◽

...

Keyword(s):

Heart Failure ◽

Health Care ◽

Palliative Care ◽

Health Care Professionals ◽

Cross Sectional Survey ◽

Cross Sectional ◽

German Health ◽

Patients With Heart Failure ◽

Facilitators And Barriers

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Telemonitoring in Heart Failure Rehabilitation

European Cardiology Review ◽

10.15420/ecr.2011.7.1.66 ◽

2011 ◽

Vol 7 (1) ◽

pp. 66 ◽

Cited By ~ 4

Author(s):

Ewa Piotrowicz ◽

Ryszard Piotrowicz ◽

◽

Keyword(s):

Heart Failure ◽

Cardiac Rehabilitation ◽

Ecg Monitoring ◽

Heart Rate Monitoring ◽

Electrocardiographic Monitoring ◽

Number Of Patients ◽

Patients With Heart Failure ◽

Related Quality ◽

Health Related

Exercise training (ET) is now recommended as an important component of a comprehensive approach to patients with heart failure (HF). Despite the existence of proven benefits of ET, many HF patients remain physically inactive. Introducing telerehabilitation (TR) may eliminate most of the factors that result in the currently low number of patients undergoing outpatient-based rehabilitation programmes and thus increase the percentage of those who will undergo cardiac rehabilitation. Despite the fact that TR is highly applicable and effective, there are few papers dedicated to the study of TR in HF patients. Until recently, only a couple of home rehabilitation-monitoring models have been presented, from the simplest, i.e. heart rate monitoring and transtelephonic electrocardiographic monitoring, through to the more advanced tele-electocardiogram (tele-ECG) monitoring (via a remote device) and realtime electrocardiographic and voice transtelephonic monitoring. It seems the last two are the most useful and reliable. Based on published studies, TR in HF patients could be equally effective as and provide similar improvements in health-related quality of life to standard outpatient cardiac rehabilitation. In addition, adherence to cardiac rehabilitation seems to be better during TR. Due to disease-related limitations, TR seems to be a viable alternative for comprehensive cardiac rehabilitation in HF patients. Further studies are needed to confirm the utility of this type of rehabilitation in routine clinical practice, including its cost-effectiveness. Because of the diversity of technological systems, it is necessary to create a platform to ensure compatibility between the devices used in telemedicine.

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Circulatory Status and Response to Cardiac Rehabilitation in Patients With Heart Failure

Circulation ◽

10.1161/01.cir.94.7.1567 ◽

1996 ◽

Vol 94 (7) ◽

pp. 1567-1572 ◽

Cited By ~ 77

Author(s):

John R. Wilson ◽

Jay Groves ◽

Glenn Rayos

Keyword(s):

Heart Failure ◽

Cardiac Rehabilitation ◽

Patients With Heart Failure

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Hidden bedside rationing in the Netherlands: a cross-sectional survey among physicians in internal medicine

BMC Health Services Research ◽

10.1186/s12913-021-06229-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ursula W. de Ruijter ◽

Hester F. Lingsma ◽

Willem A. Bax ◽

Johan Legemaate

Keyword(s):

Internal Medicine ◽

The Netherlands ◽

Patient Choice ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Physician Characteristics ◽

Distribution Of Resources ◽

Healthcare Rationing ◽

Do So

Abstract Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice. Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics. Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n = 203). Most participants (n = 129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n = 153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR = 17 95%CI 6.1–48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR = 3.2, 95%CI 2.1–4.7), while salaried physicians were less likely to do so than physicians in private practice (OR = 0.5, 95%CI 0.4–0.8). Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.

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