Key result
Interventions to increase cardiac rehabilitation utilization significantly improved patient enrolment (RR 1.27; 95% CI 1.13-1.42), adherence, and program completion.
Why the study?
Too few patients utilize cardiac rehabilitation despite its established benefits.
Do targeted interventions increase the utilization (enrolment, adherence, and completion) of cardiac rehabilitation in adults with cardiovascular disease?
Meta-Analysis (n=5,299)
Do targeted interventions increase the utilization (enrolment, adherence, and completion) of cardiac rehabilitation in adults with cardiovascular disease?
Relative Risk: 1.27 (95% CI 1.13–1.42)
Interventions, particularly those delivered face-to-face by nurses or allied healthcare providers, effectively increase patient enrolment, adherence, and completion of cardiac rehabilitation programs.
Interventions improve CR completion; extends prior Cochrane evidence to support routine implementation in post-MI and HF pathways.
Too few patients utilize cardiac rehabilitation (CR), despite its benefits. The Cochrane review assessing the effectiveness of interventions to increase CR utilization (enrolment, adherence, and completion) was updated. A search was performed through July 2018 of the Cochrane and MEDLINE (Medical Literature Analysis and Retrieval System Online) databases, among other sources. Randomized controlled trials in adults with myocardial infarction, angina, revascularization, or heart failure were included. Interventions had to aim to increase utilization of comprehensive phase II CR. Two authors independently performed all stages of citation processing. Following the random-effects meta-analysis, meta-regression was undertaken to explore the impact of pre-specified factors. Twenty-six trials with 5299 participants were included (35.8% women). Low-quality evidence showed an effect of interventions in increasing enrolment (risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.13–1.42). Meta-regression analyses suggested that the intervention deliverer (nurse or allied healthcare provider, p = 0.02) and delivery format (face-to-face, p = 0.01) were influential in increasing enrolment. There was low-quality evidence that interventions to increase adherence were effective (standardized mean difference (SMD) = 0.38, 95% CI = 0.20–0.55), particularly where remotely-offered (SMD = 0.56, 95% CI = 0.36–0.76). There was moderate-quality evidence that interventions to increase program completion were effective (RR = 1.13, 95% CI = 1.02–1.25). There are effective interventions to increase CR utilization, but more research is needed to establish specific, implementable materials and protocols, particularly for completion.
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Pio et al. (2019) conducted a meta-analysis in Myocardial infarction, angina, revascularization, or heart failure (n=5,299). Interventions to increase cardiac rehabilitation utilization vs. Standard care or no intervention was evaluated on Cardiac rehabilitation enrolment (RR 1.27, 95% CI 1.13-1.42). Interventions to increase cardiac rehabilitation utilization significantly improved patient enrolment (RR 1.27; 95% CI 1.13-1.42), adherence, and program completion.
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