July 25, 2019Open Access
View Full PaperRegional Differences in Exercise Training Implementation in Heart Failure: Findings from the Exercise Training in Heart Failure (ExTraHF) Survey
Key Result
Implementation of exercise training programmes for heart failure patients varied by region, with higher rates in Western (76%) and Northern (63%) regions compared to extra-European regions (36%).
Study Design
Type
Cross-Sectional (n=78,514)
Multicenter
Yes
Structured PICO
What are the regional variations and barriers in the implementation of exercise training programmes for heart failure patients in ESC-affiliated countries?
P
Population
172 cardiac units in charge of 78,514 heart failure patients across 5 regions (Northern, Southern, Western, Eastern European, and extra-European countries affiliated to the European Society of Cardiology)
I
Intervention
Implementation of exercise training programmes (ETPs)
C
Comparator
Regional variations (Northern vs. Southern vs. Western vs. Eastern European vs. extra-European)
O
Outcome
Rates of ETP implementation and barriers to implementation
Exercise training programmes for heart failure are poorly implemented across ESC-affiliated countries, primarily due to a lack of resources and guideline integration, with significant regional variations.
Abstract
BACKGROUND: Exercise training programmes (ETPs) are a crucial component in cardiac rehabilitation in heart failure (HF) patients. The Exercise Training in HF (ExTraHF) survey has reported poor implementation of ETPs in countries affiliated to the European Society of Cardiology (ESC). The aim of the present sub-analysis was to investigate the regional variations in the implementation of ETPs for HF patients. METHODS AND RESULTS: The study was designed as a web-based survey of cardiac units, divided into five areas, according to the geographical location of the countries surveyed. Overall, 172 centres replied to the survey, in charge of 78 514 patients, differentiated in 52 Northern (n = 15 040), 48 Southern (n = 27 127), 34 Western (n = 11 769), 24 Eastern European (n = 12 748), and 14 extra-European centres (n = 11 830). Greater ETP implementation was observed in Western (76%) and Northern (63%) regions, whereas lower rates were seen in Southern (58%), Eastern European (50%) and extra-European (36%) regions. The leading barrier was the lack of resources in all (83-65%) but Western region (37%) where patients were enrolled in dedicated settings and specialized units (75%). In 40% of centres, non-inclusion of ETP in the national or local guideline pathway accounted for the lack of ETP implementation. CONCLUSION: Exercise training programmes are poorly implemented in the ESC affiliated countries, mainly because of the lack of resources and/or national and local guidelines. The linkage with dedicated cardiac rehabilitation centres (as in the Western region) or the model of local rehabilitation services adopted in Northern countries may be considered as options to overcome these gaps.