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Interventions to Promote Patient Utilization of Cardiac Rehabilitation: Cochrane Systematic Review and Meta-Analysis

School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada
Department of Physical Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG 31270-901, Brazil
School of Social and Community Medicine, University of Bristol, Queens Road, Bristol BS8 1QU, UK
Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter EX1 2LU, UK
Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 399 Bathurst St, Toronto, ON M5T 2S8, Canada
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(2), 189;
Received: 4 January 2019 / Revised: 28 January 2019 / Accepted: 30 January 2019 / Published: 5 February 2019
(This article belongs to the Special Issue Cardiac Rehabilitation)
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. View Full-Text
Keywords: coronary artery disease; secondary prevention; healthcare access; cardiac rehabilitation coronary artery disease; secondary prevention; healthcare access; cardiac rehabilitation
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Santiago de Araújo Pio, C.; Chaves, G.; Davies, P.; Taylor, R.; Grace, S. Interventions to Promote Patient Utilization of Cardiac Rehabilitation: Cochrane Systematic Review and Meta-Analysis. J. Clin. Med. 2019, 8, 189.

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