The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial

Rachel Dankner, Galit Geulayov, Arnona Ziv, Ilia Novikov, Uri Goldbourt, Yaakov Drory, Rachel Dankner, Galit Geulayov, Arnona Ziv, Ilia Novikov, Uri Goldbourt, Yaakov Drory

Abstract

Background: Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients, and has been found to be cost-effective. This report describes a comprehensive and low cost educational intervention designed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery.

Methods/design: A controlled prospective intervention trial. The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel. This group received no additional treatment beyond usual care. The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006. This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment. The medical staff attended a one-hour seminar on cardiac rehabilitation. In addition, it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital. Both study groups were interviewed before surgery and one-year post surgery. A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs, as well as the structure and content of the cardiac rehabilitation programs attended. Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records. The effect of cardiac rehabilitation on one- and three-year mortality was assessed.

Discussion: We report a low cost yet comprehensive intervention designed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation.

Trial registration: ClinicalTrials.gov: NCT00356863.

Figures

Figure 1
Figure 1
Study Design.
Figure 2
Figure 2
Study population and study sample.

References

    1. U.S. Department of Health and Human Services. Cardiac Rehabilitation. Clinical Practice Guideline. 1995;17:1–202.
    1. NHS Center for Reviews and Dissemination. NHS Centre for Reviews and Dissemination (NHSCRD) Effective Health Care. University of York; 1998. Cardiac rehabilitation.
    1. Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001;1:CD001800.
    1. Simchen E, Naveh I, Zitzer-Gurevich Y, Brown D, Galai N. Is participation in a cardiac rehabilitation program associated with better quality of life and return to work after coronary artery bypass operation? IMAJ. 2001;3:399–403.
    1. Ades PA, Green NM, Coello CE. Effects of exercise and cardiac rehabilitation on cardiovascular outcomes. Cardiol Clin. 2003;21:435–448. doi: 10.1016/S0733-8651(03)00056-0. viii.
    1. Oldridge NB. Cardiac rehabilitation and risk factor management after myocardial infarction: clinical and economic evaluation. Wiener Klinische Wochenschrift. 1997;109(Supplement 2):6–16.
    1. Ades PA, Pashkow FJ, Nestor JR. Cost-effectiveness of cardiac rehabilitation after myocardial infarction. J Cardiopulm Rehab. 1997;17:222–231. doi: 10.1097/00008483-199707000-00002.
    1. Mozes B, Olmer L, Galai N, Simchen E. The Israel Coronary Artery Bypass (ISCAB) Study. A national study of postoperative mortality associated with coronary artery bypass grafting in Israel. ISCAB Consortium. Israel Coronary Artery Bypass Study. Ann Thorac Surg. 1998;66:1254–62. doi: 10.1016/S0003-4975(98)00586-4.
    1. King KM, Humen DP, Smith HL, Phan CL, Teo KK. Predicting and explaining cardiac rehabilitation attendance. Can J Cardiol. 2001;17:291–6.
    1. Drory Y. Cardiac rehabilitation after coronary artery bypass graft surgery: urgently needed! Isr Med Assoc J. 2001;3:427–9.
    1. Pasquali SK, Alexander KP, Lytle BL, Coombs LP, Peterson ED. Testing an intervention to increase cardiac rehabilitation enrollment after coronary artery bypass grafting. Am J Cardiol. 2001;88:1415–1416. doi: 10.1016/S0002-9149(01)02123-3. A6.
    1. Sethi PS, Nance J, Johnson D, Wilke J, Wilson K, Hall R, Romero-Vagedes F, Wilson C, Jones W, Dye D, Dzurick J, Ohm J, Ericson P, Wendel C, Mohler J, Dahiya R, Dick E, Thai H, Goldman S, Rhenman B, Morrison DA. A comprehensive cardiac rehabilitation program in post-CABG patients: a rationale and critical pathway. Crit Pathw Cardiol. 2003;1:20–33.
    1. Fleiss JL. Statistical methods for rates and proportions. New York, John Wiley & Sons; 1991. Determining sample size needed to detect a difference between two proportions; pp. 33–49.
    1. Ken-Dror G, Lerman Y, Segev S, Dankner R. Development of a Hebrew questionnaire to be used in epidemiological studies to assess physical fitness--validation against sub maximal stress test and predicted VO2max. Harefuah. 2004;143:566–72. 623. Hebrew.
    1. Ware JE, Sherbourne CD. The MOS 36-item short form health survey. SF-36: Conceptual framework and item selection. Med Care. 1992;30:473–483. doi: 10.1097/00005650-199206000-00002.
    1. Mahler DA, Mackowiak JI. Evaluation of the short-form 36-item questionnaire to measure health related quality of life in patients with COPD. Chest. 1995;107:1585–1589. doi: 10.1378/chest.107.6.1585.
    1. Dixon T, Lim LL, Oldridge NB. The MacNew heart disease health-related quality of life instrument: reference data for users. Qual Life Res. 2002;11:173–83. doi: 10.1023/A:1015005109731.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Suaya JA, Stason WB, Ades PA, Normand SL, Shepard DS. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol. 2009;54:25–33. doi: 10.1016/j.jacc.2009.01.078.
    1. Jackson L, Leclerc J, Erskine Y, Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart. 2005;91:10–14. doi: 10.1136/hrt.2004.045559.
    1. Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007;116:1653–1662. doi: 10.1161/CIRCULATIONAHA.107.701466.
    1. Thompson DR, Clark AM. Cardiac rehabilitation: into the future. Heart. 2009;95:1897–1900. doi: 10.1136/hrt.2009.173732.
    1. Grace SL, Chessex C, Arthur H, Chan S, Cyr C, Dafoe W, Juneau M, Oh P, Suskin N, Poirier P, Stevenson R, Stone J. Systematizing Inpatient Referral to Cardiac Rehabilitation: A joint policy position of the Canadian Association of Cardiac Rehabilitation and Canadian Cardiovascular Society. CJC. 2011;27:192–199.
    1. Gravely-Witte S, Leung YW, Nariani R, Tamim H, Oh P, Chan VM, Grace SL. Effects of cardiac rehabilitation referral strategies on referral and enrollment rates. Nat Rev Cardiol. 2010;72:87–96.
    1. Brown TM, Hernandez AF, Bittner V, Cannon CP, Ellrodt G, Liang L, Peterson ED, Piña IL, Safford MM, Fonarow GC. American Heart Association Get with the Guidelines Investigators. Predictors of cardiac rehabilitation referral in coronary artery disease patients: findings from the American Heart Association's Get with the Guidelines Program. J Am Coll Cardiol. 2009;54:515–521. doi: 10.1016/j.jacc.2009.02.080.
    1. AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. Circulation. 2007;116:1611–1642.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit