School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Health Sciences, University of York, York, UK.
BMC Health Serv Res. 2021 Nov 24;21(1):1267. doi: 10.1186/s12913-021-07174-w.
There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences.
A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources.
Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were 'the organisation of healthcare system', 'the organisation of cardiac rehabilitation programmes', 'healthcare professional' factors and 'guidelines'. The most frequent themes included 'lack of resources: time, staff, facilities and equipment' and 'professional's knowledge, awareness and attitude'.
Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research.
在为心力衰竭患者提供心脏康复服务方面，一直存在着研究与实践之间的差距。尽管有充分的证据证实，综合心脏康复可以改善心力衰竭患者的生活质量，并降低发病率和死亡率，但只有一小部分符合条件的患者接受了这种治疗。许多研究和综述已经确定了可能导致这种差异的患者层面的障碍，但对于提供者和系统层面的影响知之甚少。
采用叙述性综合的系统评价方法。系统评价的目的是：a）确定影响心力衰竭患者心脏康复服务提供的提供者和系统层面的障碍和促进因素；b）将确定的障碍与文献中报道的可能解决方案进行对比。采用全面的搜索策略，对 MEDLINE、Embase、PsycINFO、CINAHL Plus、EThoS 和 ProQuest 数据库进行了搜索。如果文章是实证的、同行评议的、在任何环境中进行的、使用任何研究设计，并描述了影响心力衰竭患者心脏康复服务提供的因素，则将其纳入。使用归纳主题分析和三角测量协议对数据进行综合分析，以确定不同数据源之间的一致性/矛盾。
确定了 7 项符合条件的研究。主题分析确定了 9 个总体障碍和促进因素类别，分别分为 24 个和 26 个主题。最常见的类别是“医疗保健系统的组织”、“心脏康复计划的组织”、“医疗保健专业人员”因素和“指南”。最常见的主题包括“缺乏资源：时间、人员、设施和设备”和“专业人员的知识、意识和态度”。
我们的系统评价确定了广泛的提供者和系统层面的障碍，这些障碍影响了心力衰竭患者的心脏康复服务提供，同时还确定了一系列潜在的解决方案。这些信息可能对医疗保健专业人员提供、计划或委托心脏康复服务有用，也可为未来的研究提供参考。
