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Wasilewski M, Vijayakumar A, Szigeti Z, Sathakaran S, Wang KW, Saporta A, Hitzig SL. Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review. J Multidiscip Healthc 2023; 16:2361-2376. [PMID: 37605772 PMCID: PMC10440091 DOI: 10.2147/jmdh.s418803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Objective The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR). Methods A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted. Results The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices. Conclusion ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.
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Affiliation(s)
- Marina Wasilewski
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Abirami Vijayakumar
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Zara Szigeti
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sahana Sathakaran
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Adam Saporta
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sander L Hitzig
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
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Ishihara K, Izawa KP, Kitamura M, Ogawa M, Shimogai T, Kanejima Y, Morisawa T, Shimizu I. Impact of mild cognitive impairment on unplanned readmission in patients with coronary artery disease. Eur J Cardiovasc Nurs 2021; 21:348-355. [PMID: 34718506 DOI: 10.1093/eurjcn/zvab091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023]
Abstract
AIMS To investigate the effect of mild cognitive impairment (MCI) on unplanned readmission in patients with coronary artery disease (CAD). METHODS AND RESULTS From 2132 CAD patients, MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in 243 non-dementia patients who met the study criteria. The primary outcome was unplanned hospital readmission after discharge. The incidence of MCI in this cohort was 33.3%, and 51 patients (21.0%) had unplanned readmission during a mean follow-up period of 418.6 ± 203.5 days. After adjusting for the covariates, MCI (hazard ratio, 2.28; 95% confidence interval: 1.09-4.76; P = 0.03) was independently associated with unplanned readmission in the multivariable Cox proportional hazard regression analysis. In the Kaplan-Meier analysis, the cumulative incidence of unplanned readmission for the MCI group was significantly higher than that for the non-MCI group (log-rank test, P < 0.001). Even after exclusion of the patients readmitted within 30 days of discharge, the main results did not change (log-rank test, P < 0.001). CONCLUSION Mild cognitive impairment was independently associated with unplanned readmission after adjustment for many independent variables in CAD patients. In addition to its short-term effects, the adverse effects of MCI had a persistent, long-term impact on CAD patients. Assessment of cognitive function should be conducted by health professionals prior to hospital discharge and during follow-up. To prevent readmission of CAD patients, it will be necessary to support solutions to the problems that inhibit secondary prevention behaviours based on the assessment of the patients' cognitive function.
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Affiliation(s)
- Kodai Ishihara
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama 700-0804, Japan.,Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 1-13 Wajirooka 2-chome, Higashi-ku, Fukuoka 811-0213, Japan
| | - Masato Ogawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Department of Rehabilitation Medicine, Kobe University Hospital, 5-2 Kusunokicho 7-chome, Chuo-ku, Kobe 650-0017, Japan
| | - Takayuki Shimogai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe 650-0047, Japan
| | - Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan.,Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe 650-0047, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ikki Shimizu
- Department of Diabetes, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama 700-0804, Japan
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Komaki K, Yoshida N, Satomi-Kobayashi S, Tsuboi Y, Ogawa M, Wakida K, Toba T, Kawamori H, Otake H, Omura A, Yamanaka K, Inoue T, Yamashita T, Sakai Y, Izawa KP, Okada K, Hirata KI. Preoperative frailty affects postoperative complications, exercise capacity, and home discharge rates after surgical and transcatheter aortic valve replacement. Heart Vessels 2021; 36:1234-1245. [PMID: 33615425 PMCID: PMC7897515 DOI: 10.1007/s00380-021-01793-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/22/2021] [Indexed: 01/06/2023]
Abstract
Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively (p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions.
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Affiliation(s)
- Kodai Komaki
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Naofumi Yoshida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Seimi Satomi-Kobayashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Yasunori Tsuboi
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Masato Ogawa
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kumiko Wakida
- Department of Nutrition, Kobe University Hospital, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Atsushi Omura
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsuhiro Yamanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoya Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Impact of Oral Health Status on Postoperative Complications and Functional Recovery After Cardiovascular Surgery. CJC Open 2020; 3:276-284. [PMID: 33778444 PMCID: PMC7984977 DOI: 10.1016/j.cjco.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Poor oral health status can lead to a deteriorated level of general health and is common among patients undergoing cardiovascular surgery. However, the effect of oral health status on postoperative outcomes in cardiovascular surgery patients remains unclear. Thus, we investigated the effect of preoperative oral health status on postoperative complications and functional recovery after cardiovascular surgery. Methods This single-centre retrospective cohort study included 884 inpatients undergoing elective cardiovascular surgery. Oral health status was assessed based on the number of remaining teeth, use of dentures, occlusal support, and periodontal status. We investigated postoperative complications related to surgery and postoperative functional recovery by measuring the reacquisition of walking ability, activities of daily living, and length of postoperative hospital stay. Results In this cohort (age 66.9 ± 13.4 years), the mean number of remaining teeth was 18.7 ± 9.4. Patients were grouped based on tertiles of the data distribution of remaining teeth: ≥ 20 teeth (470 patients); 10-19 teeth (137 patients); < 10 teeth (185 patients). The number of missing teeth was associated with age (P < 0.001). The prevalence of postoperative pneumonia and reintubation after surgery was 3.2% and 2.5%, respectively, which was significantly higher in patients with severe tooth loss (P < 0.05 for both). After adjusting for age and other confounding factors, the number of remaining teeth was a statistically significant predictor of functional recovery (P < 0.05). Conclusions Preoperative oral health status was related to postoperative respiratory complications and independently associated with functional recovery. Preoperative oral intervention may improve functional recovery after cardiovascular surgery.
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Holst KA. Commentary: Lessons learned from multidisciplinary inpatient rehabilitation following cardiac surgery and the gap to broad application. J Thorac Cardiovasc Surg 2020; 161:1862-1863. [PMID: 32033816 DOI: 10.1016/j.jtcvs.2019.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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Masterson Creber RM, Gaudino MFL. Commentary: "Get moving early!" Inpatient cardiac rehabilitation reduces unplanned hospitalizations. J Thorac Cardiovasc Surg 2020; 161:1861-1862. [PMID: 31926729 PMCID: PMC7316606 DOI: 10.1016/j.jtcvs.2019.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ruth M Masterson Creber
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
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