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Dr. Sherry Grace and Carolina Santiago
Dr. Sherry Grace (L) and Carolina Santiago led a study that found face-to-face encouragement from healthcare providers is key to getting more people in cardiac rehab programs. (Photos: UHN)

Face-to-face encouragement by a member of the healthcare team, preferably when patients are still in hospital, may boost subsequent enrolment in cardiac rehab by as much as 60 per cent, a new study finds.

The results, from researchers at Peter Munk Cardiac Centre (PMCC) and Toronto Rehabilitation Institute, are welcome findings given that, in spite of the benefits, enrolment is very low in cardiac rehab programs.

"Healthcare providers need to explicitly encourage patients to attend, and make sure they answer any patient questions about taking part," explains Carolina Santiago, York University PhD student and physiotherapist, who co-authored the study, which was led by Dr. Sherry Grace of PMCC and TRI.

The researchers sought to determine how to encourage more patients to use cardiac rehab programs in a review published on Feb. 1, the start of Heart Month, in the Cochrane Library. This updated review incorporates new trials and provides evidence to suggest what makes a difference.

heart month logo​The review found strategies to increase enrolment may be effective, particularly those that target healthcare providers, training nurses, or allied healthcare providers to intervene face-to-face.

It found face-to-face encouragement by a member of the healthcare team, preferably when patients are still in hospital, may boost subsequent enrolment in cardiac rehab by as much as 60 per cent.

The review also found that interventions to increase adherence to programs and to increase completion are probably effective, particularly when cardiac rehabilitation was unsupervised.

'The more people who are encouraged to attend and gain access, the better'

Heart disease is the leading cause of death and disability globally. Participation in cardiac rehab increases people's chance at life, and lessens their chances of being hospitalized again.

Cardiac rehab is strongly recommended for patients with heart failure, or those who have undergone coronary stent placement, or bypass surgery (among others).

Patients are generally offered sessions a couple of times a week over about five months. Components of most programs include exercise, counselling, nutrition and patient education to control risk factors.

Physicians need to refer their patients, but even where they do, many patients do not enroll in the program. They may not realize how important it is to their recovery because providers may not be promoting it.

"We have established ways to overcome most patient barriers to attending cardiac rehab such as distance, language or cost, and we need to talk with patients about them face-to-face," says co-author Rod Taylor, professor from University of Exeter, U.K., who has for years been tracking evidence on how best to boost use of these programs for years. 

The researchers developed a position statement based on their findings, calling on policy-makers and healthcare providers to ensure their recommendations are put into place. Many medical societies around the world are endorsing the statement, and helping spread the word about the benefits of cardiac rehab.

Researchers have also developed an online course that offers healthcare providers information about the impact of their promotion of cardiac rehab to patients, and about what patients need to hear to optimize their enrolment. It is available at UHN, and will later be made available globally.

"Cardiac rehab makes a fundamental difference in people's lives – the more people who are encouraged to attend and gain access, the better," says Dr. Grace, who is also a professor at York University. ​​

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