Despite strong evidence for the benefits of cardiac rehabilitation, attendance/completion rates remain low. Nurse practitioner-led services have been reported as more effective than physician-led services at increasing patient adherence to evidence-based recommendations. However, nurse practitioner-led programmes are uncommon and there appears to be no current evidence examining the impact of these programmes on attendance/completion rates.

Methods

A retrospective audit of the Country Access to Cardiac Health (CATCH) database was undertaken to identify patients who attended a nurse practitioner-led cardiac rehabilitation programme between April 2014 and May 2016. Data from key performance indicators were exported to Stata/SE 15.0. The study utilised the Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies to ensure quality reporting during this study (See Data S1).

Results

Seventy-seven per cent (n = 199) of participants were men, and participants had a mean age of 67 years. Half (52.5%) of participants completed all CR sessions. Male participants (78%) were more likely to complete the CR programme as compared with women (67%).

Participants with a family history of cardiovascular disease and a higher number of risk factors at baseline were more likely to commence and complete the programme. Attendance and completion had a positive impact on smoking cessation.

Conclusions

The nurse practitioner-led programme evaluated in this study demonstrated high levels of attendance and completion rates compared to standard programmes. This high attendance/completion rate could in turn decrease the rate of subsequent cardiac events and improve mortality and morbidity rates.

Relevance to clinical practice provides valuable insights into the effectiveness of nurse practitioner-led cardiac rehabilitation and secondary prevention on attendance/complete rates. These findings could guide future research and clinical practice development.

CONFLICT OF INTEREST

No conflict of interest has been declared by the author(s).

Supporting Information

REFERENCES

Ades, P. A., Keteyian, S. J., Wright, J. S., Hamm, L. F., Lui, K., Newlin, K., Thomas, R. J. (2017). Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clinic Proceedings, 92(2), 234–242.
10.1016/j.mayocp.2016.10.014
PubMed Web of Science® Google Scholar
Australian Bureau of Statics. Causes of Death 2011. (3303.0) (2013). Australian Institute of Health and Welfare's Australia Health Report 2016. http://www.aihw.gov.au/publications/aus/ah08/ah08.pdf
Google Scholar
Australian Commission on Safety and Quality in Health Care. (2014). Acute Coronary Syndromes Clinical Care Standard. Sydney: ACSQHC.
Google Scholar
Benatar, J., Doolan-Noble, F., & McLachlan, A. (2016). Cardiac rehabilitation in New Zealand-moving forward. New Zealand Medical Journal, 129. 68-74.
PubMed Web of Science® Google Scholar
Briffa, T. G., Kinsman, L., Maiorana, A. J., Zecchin, R., Redfern, J., Davidson, P. M., … Denniss, A. R. (2009). An integrated and coordinated approach to preventing recurrent coronary heart disease events in Australia. Medical Journal of Australia, 190(12), 683–686. https://doi.org/10.5694/j.1326-5377.2009.tb02636.x
10.5694/j.1326-5377.2009.tb02636.x
PubMed Web of Science® Google Scholar
Clark, A. M., King-Shier, K. M., Duncan, A., Spaling, M., Stone, J. A., Jaglal, S., & Angus, J. (2013). Factors influencing referral to cardiac rehabilitation and secondary prevention programs: A systematic review. European Journal of Preventive Cardiology, 20(4), 692–700. https://doi.org/10.1177/2047487312447846
10.1177/2047487312447846
PubMed Web of Science® Google Scholar
Clark, R. A., Coffee, N., Turner, D., Eckert, K. A., van Gaans, D., Wilkinson, D., … Tonkin, A. M. (2014). Access to cardiac rehabilitation does not equate to attendance. European Journal of Cardiovascular Nursing, 13(3), 235–242. https://doi.org/10.1177/1474515113486376
10.1177/1474515113486376
PubMed Web of Science® Google Scholar
Colbert, J. D., Martin, B.-J., Haykowsky, M. J., Hauer, T. L., Austford, L. D., Arena, R. A., … Stone, J. A. (2015). Cardiac rehabilitation referral, attendance and mortality in women. European Journal of Preventive Cardiology, 22(8), 979–986. https://doi.org/10.1177/2047487314545279
10.1177/2047487314545279
PubMed Web of Science® Google Scholar
Colella, T. J., Gravely, S., Marzolini, S., Grace, S. L., Francis, J. A., Oh, P., & Scott, L. B. (2015). Sex bias in referral of women to outpatient cardiac rehabilitation? A meta-analysis. European Journal of Preventive Cardiology, 22(4), 423–441. https://doi.org/10.1177/2047487314520783
10.1177/2047487314520783
PubMed Web of Science® Google Scholar
Critchley, J. A., & Capewell, S. (2003). Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: A systematic review. JAMA, 290(1), 86–97. https://doi.org/10.1001/jama.290.1.86
10.1001/jama.290.1.86
PubMed Web of Science® Google Scholar
Dalal, H. M., Doherty, P., & Taylor, R. S. (2015). Cardiac rehabilitation. BMJ, 351, h5000. https://doi.org/10.1136/bmj.h5000
10.1136/bmj.h5000
PubMed Web of Science® Google Scholar
Economics, D. A. (2011). ACS in perspective: The importance of secondary prevention. Canberra: Deloitte Access Economics Pty Ltd. https://www2.deloitte.com/au/en/pages/economics/articles/acs-perspective-importance-secondary-prevention.html
Google Scholar
Feola, M., Garnero, S., Daniele, B., Mento, C., Dell'Aira, F., Chizzolini, G., & Testa, M. (2015). Gender differences in the efficacy of cardiovascular rehabilitation in patients after cardiac surgery procedures. Journal of Geriatric Cardiology: JGC, 12(5), 575.
PubMed Web of Science® Google Scholar
Galdas, P. M., Harrison, A. S., & Doherty, P. (2018). Gender differences in the factors predicting initial engagement at cardiac rehabilitation. Open Heart, 5(1), e000764. https://doi.org/10.1136/openhrt-2017-000764
10.1136/openhrt-2017-000764
PubMed Web of Science® Google Scholar
Grace, S. L., Angevaare, K. L., Reid, R. D., Oh, P., Anand, S., Gupta, M., … Stewart, D. E. (2012). Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: A prospective, multi-site study. Implementation Science, 7(1), 120. https://doi.org/10.1186/1748-5908-7-120
10.1186/1748-5908-7-120
PubMed Web of Science® Google Scholar
Grace, S. L., Gravely-Witte, S., Kayaniyil, S., Brual, J., Suskin, N., & Stewart, D. E. (2009). A multisite examination of sex differences in cardiac rehabilitation barriers by participation status. Journal of Women's Health, 18(2), 209–216. https://doi.org/10.1089/jwh.2007.0753
10.1089/jwh.2007.0753
PubMed Web of Science® Google Scholar
Grace, S. L., Russell, K. L., Reid, R. D., Oh, P., Anand, S., Rush, J., … Stewart, D. E. (2011). Effect of cardiac rehabilitation referral strategies on utilization rates: A prospective, controlled study. Archives of Internal Medicine, 171(3), 235–241. https://doi.org/10.1001/archinternmed.2010.501
10.1001/archinternmed.2010.501
PubMed Google Scholar
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: the Online Journal of Issues in Nursing, 19(2).https://doi.org/10.3912/OJIN.Vol19No02Man02
PubMed Google Scholar
Harbman, P. (2014). The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: A prospective cohort study. International Journal of Nursing Studies, 51(12), 1542–1556. https://doi.org/10.1016/j.ijnurstu.2014.04.004
10.1016/j.ijnurstu.2014.04.004
PubMed Web of Science® Google Scholar
Harrison, A. S., Doherty, P., & Phillips, A. (2018). An analysis of barriers to entry of cardiac rehabilitation in patients with diabetes: Using data from the National Audit of Cardiac Rehabilitation. Diabetes and Vascular Disease Research, 15(2), 145–149. https://doi.org/10.1177/1479164117744490
10.1177/1479164117744490
PubMed Web of Science® Google Scholar
Janssen, V., De Gucht, V., van Exel, H., & Maes, S. (2013). Beyond resolutions? A randomized controlled trial of a self-regulation lifestyle programme for post-cardiac rehabilitation patients. European Journal of Preventive Cardiology, 20(3), 431–441. https://doi.org/10.1177/2047487312441728
10.1177/2047487312441728
PubMed Web of Science® Google Scholar
Janssen, V. R., & Kraaijenhagen, R. A. (2016). Do it yourself healthcare: A three-step approach to supporting patient self-management in clinical practice. The Eighth International Conference on eHealth, Telemedicine, and Social Medicine, Venice.
Google Scholar
Jelinek, M. V., Thompson, D. R., Ski, C., Bunker, S., & Vale, M. J. (2015). 40 years of cardiac rehabilitation and secondary prevention in post-cardiac ischaemic patients. Are we still in the wilderness? International Journal of Cardiology, 179, 153–159. https://doi.org/10.1016/j.ijcard.2014.10.154
10.1016/j.ijcard.2014.10.154
PubMed Web of Science® Google Scholar
Jorstad, H. T., von Birgelen, C., Alings, A. M. W., Liem, A., van Dantzig, J. M., Jaarsma, W., … Peters, R. J. G. (2013). Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: Main results of the RESPONSE randomised trial. Heart, 99(19), 1421–1430. https://doi.org/10.1136/heartjnl-2013-303989
10.1136/heartjnl-2013-303989
PubMed Web of Science® Google Scholar
Krum, H., & Driscoll, A. (2013). Management of heart failure. Medical Journal of Australia, 199(5), 334–339. https://doi.org/10.5694/mja12.10993
10.5694/mja12.10993
PubMed Web of Science® Google Scholar
Lawler, P.R., Filion, K.B., & Eisenberg, M.J. (2011). Efficacy of exercise-based cardiac rehabilitation post–myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. American heart journal, 162(4), 571–584.
10.1016/j.ahj.2011.07.017
PubMed Web of Science® Google Scholar
McLachlan, A., Sutton, T., Ding, P., & Kerr, A. (2015). A nurse practitioner clinic: A novel approach to supporting patients following heart valve surgery. Heart, Lung and Circulation, 24(11), 1126–1133. https://doi.org/10.1016/j.hlc.2015.04.064
10.1016/j.hlc.2015.04.064
PubMed Web of Science® Google Scholar
National Heart Foundation of Australia. (2014). Improving the delivery of cardiac rehabilitation in Australia. https://www.heartfoundation.org.au/images/uploads/publications/Improvingthedeliveryofcardiacrehabilitationpdf
Google Scholar
Neubeck, L., Freedman, S. B., Clark, A. M., Briffa, T., Bauman, A., & Redfern, J. (2012). Participating in cardiac rehabilitation: A systematic review and meta-synthesis of qualitative data. European Journal of Preventive Cardiology, 19(3), 494–503. https://doi.org/10.1177/1741826711409326
10.1177/1741826711409326
PubMed Web of Science® Google Scholar
Pack, Q. R., Johnson, L. L., Barr, L. M., Daniels, S. R., Wolter, A. D., Squires, R. W., … Thomas, R. J. (2013). Improving cardiac rehabilitation attendance and completion through quality improvement activities and a motivational program. Journal of Cardiopulmonary Rehabilitation and Prevention, 33(3), 153. https://doi.org/10.1097/HCR.0b013e31828db386
10.1097/HCR.0b013e31828db386
PubMed Web of Science® Google Scholar
Pack, Q. R., Squires, R. W., Lopez-Jimenez, F., Lichtman, S. W., Rodriguez-Escudero, J. P., Lindenauer, P. K., & Thomas, R. J. (2015). Participation rates, process monitoring, and quality improvement among United States Cardiac Rehabilitation Programs: A National Survey. Journal of Cardiopulmonary Rehabilitation and Prevention, 35(3), 173.
10.1097/HCR.0000000000000108
PubMed Web of Science® Google Scholar
Redfern, J., Ellis, E. R., Briffa, T., & Freedman, S. B. (2007). High risk-factor level and low risk-factor knowledge in patients not accessing cardiac rehabilitation after acute coronary syndrome. Medical Journal of Australia, 186(1), 21–25. https://doi.org/10.5694/j.1326-5377.2007.tb00783.x
10.5694/j.1326-5377.2007.tb00783.x
PubMed Web of Science® Google Scholar
Redfern, J., & Chow, C.K. (2013). Secondary prevention of coronary heart disease in Australia: a blueprint for reform. Medical Journal of Australia, 198(2). 70–71
10.5694/mja12.11080
PubMed Web of Science® Google Scholar
Samayoa, L., Grace, S. L., Gravely, S., Scott, L. B., Marzolini, S., & Colella, T. J. (2014). Sex differences in cardiac rehabilitation enrollment: A meta-analysis. Canadian Journal of Cardiology, 30(7), 793–800. https://doi.org/10.1016/j.cjca.2013.11.007
10.1016/j.cjca.2013.11.007
PubMed Web of Science® Google Scholar
Snaterse, M., Scholte op Reimer, W., Dobber, J., Minneboo, M., ter Riet, G., Jorstad, H. T., … Peters, R. (2015). Smoking cessation after an acute coronary syndrome: Immediate quitters are successful quitters. Netherlands Heart Journal, 23(12), 600–607. https://doi.org/10.1007/s12471-015-0755-9
10.1007/s12471-015-0755-9
CAS PubMed Web of Science® Google Scholar
Stacy, L. M. (2016). CHF clinics: Benefits, models, utilization, and patient compliance. InSight: Rivier Academic Journal, 12(1).1–17
Google Scholar
Strömberg, A., Mårtensson, J., Fridlund, B., Levin, L. Å., Karlsson, J. E., & Dahlström, U. (2003). Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: Results from a prospective, randomised trial. European Heart Journal, 24(11), 1014–1023. https://doi.org/10.1016/S0195-668X(03)00112-X
10.1016/S0195-668X(03)00112-X
CAS PubMed Web of Science® Google Scholar
Supervía, M., Medina-Inojosa, J. R., Yeung, C., Lopez-Jimenez, F., Squires, R. W., Pérez-Terzic, C. M., Thomas, R. J. (2017). Cardiac rehabilitation for women: a systematic review of barriers and solutions. Mayo Clinic Proceedings, 92(4), 565–577.
10.1016/j.mayocp.2017.01.002
Web of Science® Google Scholar
Tameler, W. (2014). Cardiac Rehabilitation Enrollment Rates and Different Referral Strategies. Theses, Dissertations, Professional Papers. Paper 4283.
Google Scholar
Tavella, R., O’Toole, K., Tirimacco, R., Lloyd, A., Pennington, K., Drilling, S., … Keech, W. (2015). Cardiac rehabilitation referral and completion: Results from the South Australian minimum dataset for cardiac rehabilitation programs. Heart, Lung and Circulation, 24, S451–S452. https://doi.org/10.1016/j.hlc.2015.06.786
10.1016/j.hlc.2015.06.786
Google Scholar
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. http://www.equator-network.org/reporting-guidelines/strobe
Google Scholar
Tideman, P., Tirimacco, R., Berry, N., Cowley, P., Jones, S., Church, A., & Clark, R. (2015). Country access to cardiac health (CATCH) program: Improving rehospitalisation rates and length of stay for cardiac rehabilitation using innovative telehealth delivery. Heart, Lung and Circulation, 24, S453. https://doi.org/10.1016/j.hlc.2015.06.790
10.1016/j.hlc.2015.06.790
Google Scholar
Venturini, E., & Testa, R. (2014). Cardiac rehabilitation and percutaneous coronary intervention: Together against global burden of cardiovascular disease. Journal of Cardiology and Therapy, 1(1). 1–9.
Google Scholar
Wachtel, T. M. (2011). Preferred models of cardiac rehabilitation in rural South Australia from a health consumer's perspective. Australian Journal of Advanced Nursing, the, 28(3), 30.
Web of Science® Google Scholar
Wilson, T. M., Peng, Z., Clark, R. A., & Tirimacco, R. (2018). Cardiac rehabilitation and secondary prevention: Assessing patient satisfaction. British Journal of Cardiac Nursing, 13(3), 135–141. https://doi.org/10.12968/bjca.2018.13.3.135
10.12968/bjca.2018.13.3.135
Google Scholar
Woodruffe, S., Neubeck, L., Clark, R. A., Gray, K., Ferry, C., Finan, J., … Briffa, T. G. (2015). Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart, Lung and Circulation, 24(5), 430–441. https://doi.org/10.1016/j.hlc.2014.12.008
10.1016/j.hlc.2014.12.008
PubMed Web of Science® Google Scholar

Citing Literature

Volume29, Issue5-6

March 2020

Pages 785-793

Exploration of a nurse practitioner-led phase two cardiac rehabilitation programme on attendance and compliance

Abstract

Aims and Objectives

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Information

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Exploration of a nurse practitioner-led phase two cardiac rehabilitation programme on attendance and compliance

Abstract

Aims and Objectives

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Related

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