scholarly journals A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paulina Daw ◽  
Thomas M. Withers ◽  
Jet J. C. S. Veldhuijzen van Zanten ◽  
Alexander Harrison ◽  
Colin J. Greaves
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Cardiac Rehabilitation ◽  
Thematic Analysis ◽  
System Level ◽  
Future Research ◽  
Heart Failure Patients ◽  
Barriers And Enablers ◽  
Factors Influencing ◽  
Wide Range

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.

Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data

2011 ◽  
Vol 19 (3) ◽  
pp. 494-503 ◽  
Author(s):  
Lis Neubeck ◽  
S Ben Freedman ◽  
Alexander M Clark ◽  
Tom Briffa ◽  
Adrian Bauman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Rehabilitation ◽  
Grey Literature ◽  
System Level ◽  
Future Research ◽  
Physical Barriers ◽  
Key Issues ◽  
Study Methodology ◽  
Keyword Searching ◽  
Patient Barriers

Background: Participation in cardiac rehabilitation (CR) benefits patients with coronary heart disease (CHD), yet worldwide only some 15–30% of those eligible attend. To improve understanding of the reasons for poor participation we undertook a systematic review and meta-synthesis of the qualitative literature. Methods: Qualitative studies identifying patient barriers and enablers to attendance at CR were identified by searching multiple electronic databases, reference lists, relevant conference lists, grey literature, and keyword searching of the internet (1990–2010). Studies were selected if they included patients with CHD and reviewed experience or understanding about CR. Meta-synthesis was used to review the papers and to synthesize the data. Results: From 1165 papers, 34 unique studies were included after screening. These included 1213 patients from eight countries. Study methodology included interviews ( n = 25), focus groups ( n = 5), and mixed-methods ( n = 4). Key reasons for not attending CR were physical barriers, such as lack of transport, or financial cost, and personal barriers, such as embarrassment about participation, or misunderstanding the reasons for onset of CHD or the purpose of CR. Conclusions: There is a vast amount of qualitative research which investigates patients’ reasons for non-attendance at CR. Key issues include system-level and patient-level barriers, which are potentially modifiable. Future research would best be directed at investigating strategies to overcome these barriers.

Abstract 377: A Systematic Review of Medication Adherence Among African American Heart Failure Patients

2016 ◽  
Vol 119 (suppl_1) ◽  
Author(s):  
Lila de Tantillo ◽  
Rosa M Gonzalez-Guarda
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
African American ◽  
Medication Adherence ◽  
American Heart ◽  
The United States ◽  
System Level ◽  
Inclusion Criteria ◽  
Heart Failure Patients ◽  
Adaptation Model

Background: Heart failure is a leading cause of death in the United States and a condition of particular concern for the African American population. Although effective treatments are available for the disease, medication adherence is a key determinant of survival. Objective: This systematic review examines articles from the last 15 years that research medication adherence and African American heart failure patients. Methods: A systematic review of the published literature was conducted to identify articles examining predictors and outcomes of medication adherence among African Americans and then using Sister Callista Roy’s Health Adaptation conceptual framework - physiological, self-concept, role function and interdependence. Results: This review identified 14 articles that met inclusion criteria, most of which focused on physiological predictors, noting that age and comorbid conditions such as dialysis status may play a role in medication adherence. Psychological, cultural and social determinants were also found to impact adherence behaviors. Conclusions: More research is needed to examine other components of the Health Adaptation model, especially socioeconomic and healthcare system level predictors.

Influences on Academic Talent Development of Black Girls in K-12: A Systematic Review

2021 ◽  
pp. 1932202X2110138
Author(s):  
Brenda K. Davis
Keyword(s):  
Systematic Review ◽  
Racial Identity ◽  
Thematic Analysis ◽  
Systematic Approach ◽  
Talent Development ◽  
Academic Development ◽  
Black Girls ◽  
Personal Attributes ◽  
Future Research ◽  
K 12

Black girls experience numerous challenges to their academic development. This study examines the literature from the last 30 years related to the influences on the academic talent development of school-aged Black girls. Environmental and intrapersonal influences to Black girls academic talent development are explored. Using a systematic approach, 43 articles are reviewed and summarized. Thematic analysis conducted on the results and findings sections from each article reveal four major themes related to personal attributes, racial identity, relationships, and institutions. The themes expand the understanding of the complexity of talent development of Black girls and identify several intrapersonal and environmental influences that can promote or hinder academic achievement. Implications for future research are discussed.

scholarly journals Role of nurses to improve self-care in heart failure patients: a systematic review and meta-analysis

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Massimi ◽  
C De Vito ◽  
M L Rega ◽  
P Villari ◽  
G Damiani
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Meta Analysis ◽  
Self Care ◽  
Educational Interventions ◽  
Management Skills ◽  
Short Term ◽  
Post Discharge ◽  
Individual Level ◽  
Heart Failure Patients

Abstract Introduction Heart Failure (HF) is a pandemic chronic disease with a prevalence up to 3% in the general population, representing the main cause of hospitalization for people over 65. Self-care plays a central role in the management of patients with HF, showing evidence of effectiveness in reducing re-hospitalization rates and mortality. Methods We carried out a systematic review and meta-analysis to assess the efficacy of nurse-led educational interventions Vs usual care in improving self-care skills of patients with chronic HF. The main biomedical databases were searched for Randomized Control Trials (RCTs) of nurse-led educational interventions performed on adults with a previous diagnosis of HF. Improvement of HF self-management skills (self-care level) was summarized by calculating the standardized mean difference (SMD) and 95% confidence intervals (CI) stratified for the length of the follow-up. Results Globally, 14 RCTs were included involving 2078 participants. Ten studies showed the efficacy of the interventions at 3 months (short term) with a SMD of 0.78 (95% CI 0.38-1.18) in favor of the self-care education interventions. Five studies reported on self-care abilities at 6-9 months (medium term), not showing statistically significant results (SMD 0.35, 95%CI 0.11-0.81). The long-term effect of the educational interventions showed no statistically significant improvement in self-care behaviors (three studies, SMD 0.05, 95CI% 0.12 - 0.22). Conclusions These results show that nursing educational interventions improve self-care behaviors in HF, but mainly in the short term. Intensive educational interventions led by nurses, associated with appropriate continuity and transition of care, can determine the best outcomes for patients with HF, strengthening self-care behaviors over time. This approach could have a major impact not only on individual level, but on the general reduction of complications, hospitalization, medical costs and ultimately mortality. Key messages Nurse-led educational programs have a short-term efficacy in enhancing self-care behaviors among heart failure patients. Post-discharge repeated educational interventions, along with timely and shared plans ruling the transition between the hospital and the other providers, are strongly needed.

scholarly journals 104INTERVENTIONS TO ENHANCE MEDICATION ADHERENCE IN OLDER HEART FAILURE PATIENTS - A SYSTEMATIC REVIEW

2017 ◽  
Vol 46 (suppl_1) ◽  
pp. i25-i26
Author(s):  
R L Fulton ◽  
T Kroll ◽  
M E T McMurdo ◽  
G J Molloy ◽  
M D Witham
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Medication Adherence ◽  
Heart Failure Patients

scholarly journals Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Christian Akem Dimala ◽  
Noah T. Fongwen ◽  
Adrian D. Smith
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Health System ◽  
Sample Size ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
System Level ◽  
Comprehensive Treatment ◽  
Barriers And Enablers ◽  
Sub Saharan

Abstract Introduction Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients’ access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. Method A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. Results Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. Conclusions In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.

scholarly journals Effect of Uric Acid-Lowering Agents on Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Hongxuan Xu ◽  
Yunqing Liu ◽  
Lingbing Meng ◽  
Li Wang ◽  
Deping Liu
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Uric Acid ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Heart Failure Patients ◽  
All Cause Mortality ◽  
Randomised Controlled

Background: Elevated serum uric acid (SUA) level is considered an independent predictor of all-cause mortality and the combined endpoint of death or readmission in cardiovascular disease patients. However, the causal relationship between uric acid-lowering therapies (ULTs) and heart failure is still controversial.Design: Meta-analyses were performed to systematically compile available evidence to determine the overall effect of ULTs on heart failure patients.Method: We conducted this systematic review following the PRISMA statement guidelines. Databases were searched to identify randomised controlled trials related to the influence of a ULT intervention in people with heart failure. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of ULTs to a control.Results: Pooled analysis of left ventricular ejection fraction (LEVF) showed an insignificant result towards the ULT group (MD, 1.63%; 95%CI, −1.61 to 4.88; p = 0.32; three studies). Pooled analysis of the 6-Minute Walk Test (6MWT) showed an insignificant result towards the ULT group (MD, 4.59; 95%CI, −12.683 to 22.00; p = 0.61; four studies). Pooled analysis of BNP/NT-pro-BNP led to a nearly statistically significant result towards the ULT group (SMD, −0.30; 95%CI, −0.64 to 0.04; p = 0.08; five studies). Pooled analysis of all-cause mortality and cardiovascular death between ULTs (all XOIs) and placebo did not show a significant difference (RR, 1.26; 95% CI, 0.74 to 2.15, p = 0.39).Conclusion: ULTs did not improve LVEF, BNP/NT-pro-BNP, 6MWT, all-cause mortality, and CV death in heart failure patients. UA may just be a risk marker of heart failure.

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