Key result
Review identifies nine categories of provider and system barriers and enablers impacting HF CR delivery.
Why the study?
Despite evidence that cardiac rehabilitation improves outcomes in heart failure, few eligible patients receive it, and little is known about provider- and system-level influences.
What are the provider- and system-level barriers and enablers affecting the delivery of cardiac rehabilitation for patients with heart failure?
Systematic Review (n=7)
What are the provider- and system-level barriers and enablers affecting the delivery of cardiac rehabilitation for patients with heart failure?
System-level factors, particularly lack of resources and professional awareness, are major barriers to the delivery of cardiac rehabilitation for heart failure patients.
System-level barriers limit cardiac rehabilitation access for heart failure; supports targeted implementation strategies and further research.
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.
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Daw et al. (2021) conducted a systematic review in Heart failure (n=7). Provider- and system-level factors was evaluated on Provider- and system-level barriers and enablers affecting the delivery of cardiac rehabilitation. This systematic review identified nine overarching categories of provider- and system-level barriers and enablers impacting the delivery of cardiac rehabilitation for heart failure.
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