Miralles-Resurreccion Karen V, Grace Sherry L, Cuenza Lucky R
Section of Cardiac Rehabilitation, Philippine Heart Center, Quezon City, Philippines.
York University, Toronto, Ontario, Canada.
J Cardiovasc Thorac Res. 2022;14(2):84-89. doi: 10.34172/jcvtr.2022.22. Epub 2022 Jun 28.
Cardiac rehabilitation (CR) is an effective but underutilized intervention. Strategies have been identified to increase its use, but there is paucity of data testing them in low-resource settings. We sought to determine the effect of automatic referral post-coronary artery bypass graft (CABG) surgery on CR enrollment. This is a retrospective cohort study assessing cardiac patients referred to CR at a tertiary center in Southeast Asia from 2013 to 2019. The paper-based pathway was introduced at the end of 2012. The checklist with automatic CR referral on the third day post-operation prompted a nurse to educate the patient about CR, initiate phase 1 and encourage enrollment in phase 2. Patients who were not eligible for the pathway for administrative or clinical reasons were referred at the discretion of the attending physician (i.e., usual care). Enrollment was defined as attendance at≥1 CR visit. Of 4792 patients referred during the study period, 394 enrolled in CR. Significantly more patients referred automatically enrolled compared to usual care (225 [11.8%] vs. 169 [5.8%]; OR=2.2, 95% CI=1.8-2.7), with increases up to 23.4% enrollment in 2014 (vs. average enrollment rate of 5.9% under usual referral). Patients who enrolled following automatic referral were significantly younger and more often employed (both <0.001); no other differences were observed. In a lower-resource, Southeast Asian setting, automatic CR referral is associated with over two times greater enrollment in phase 2 CR, although efforts to maintain this effect are required.
心脏康复(CR)是一种有效的干预措施,但未得到充分利用。已确定了增加其使用的策略,但在资源匮乏地区对这些策略进行测试的数据很少。我们试图确定冠状动脉旁路移植术(CABG)后自动转诊对CR登记的影响。这是一项回顾性队列研究,评估了2013年至2019年在东南亚一家三级中心转诊至CR的心脏病患者。基于纸质的流程于2012年底引入。术后第三天自动进行CR转诊的检查表促使护士对患者进行CR教育,启动第一阶段并鼓励其参加第二阶段。因行政或临床原因不符合该流程的患者由主治医生酌情转诊(即常规护理)。登记定义为参加≥1次CR就诊。在研究期间转诊的4792名患者中,394名登记参加了CR。与常规护理相比,自动转诊的患者登记人数明显更多(225例[11.8%]对169例[5.8%];OR=2.2,95%CI=1.8-2.7),2014年登记人数增加高达23.4%(相比之下,常规转诊的平均登记率为5.9%)。自动转诊后登记的患者明显更年轻且就业比例更高(均<0.001);未观察到其他差异。在资源较少的东南亚地区,自动CR转诊与第二阶段CR登记人数增加两倍以上相关,尽管需要努力维持这种效果。