Abstract
Background
Cardiovascular disease is the leading cause of death worldwide. Cardiac surgery is
the main treatment followed by inpatient cardiac rehabilitation (ICR) to prepare patients
for recovery.
Aim
The aim of this study was to describe the delivery, barriers, and enablers to patient
participation in ICR programs after cardiac surgery.
Methods
This integrative review was guided by Whittemore and Knafl's methodology. This process
included database searches, data evaluation, data integration, and presentation of
results. Searched databases included Medline, CINAHL Complete, PsycINFO, Cochrane
Library, and Web of Science. Publications dates included 2000 to 2021. Studies included
Phase 1/inpatient phase cardiac rehabilitation following cardiac surgery. The Mixed
Method Appraisal Tool (2018) was used to assess the quality of the included studies.
Inductive content analysis was used to analyse the textual data.
Results
Using the inclusion and the exclusion criteria, 607 articles were screened. Five articles
were included in this review, and they were appraised. Categories comprised of the
following: i) ICR programs using a multidisciplinary approach beginning in the early
postoperative stage; ii) ICR programs including multicomponents that were delivered
through an individualised approach; and iii) enablers and barriers to patient participation
to ICR. The enablers included religious faith and family support, whereas inconsistent
pathways of cardiac rehabilitation referrals and detachment from patients' experiences
and needs were barriers to participation in ICR.
Conclusions
In some instances, ICR programs were delivered using individualised approaches, but
this is an area that needs improvement. A multidisciplinary team including nurses
should be involved in the ICR phase after cardiac surgery to provide holistic care
and enhance patients’ preparedness to participate in subsequent phases of rehabilitation.
Only five relevant articles addressing the delivery of inpatient cardiac rehabilitation
were identified in this specific topic area.
Keywords
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References
- Cardiovascular diseases.2021 (Available from:)
- Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery: a randomized, controlled trial.Ann Intern Med. 2000; 133: 253-262
- The effect of educational audiotape programme on anxiety and depression in patients undergoing coronary artery bypass graft.J Clin Nurs. 2013; 22: 1613-1619
World Health Organisation. News. Available from: https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019.
- Cardiac rehabilitation services in Ireland: the impact of a coordinated national development strategy.Ir J Med Sci. 2005; 174: 33-38
- Why do we keep asking, do we still need cardiac rehabilitation?.Eur J Prev Cardiol. 2020; 2047487320902745
- Cardiac rehabilitation.BMJ. 2015; 351: h5000-hhttps://doi.org/10.1136/bmj.h5000
- Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study.Implement Sci. 2012; 7: 120https://doi.org/10.1186/1748-5908-7-120
- Cardiac rehabilitation and secondary prevention of coronary heart disease - an American heart association scientific statement from the council on clinical cardiology (subcommittee on exercise, cardiac rehabilitation, and prevention) and the council on nutrition, physical activity, and metabolism (subcommittee on physical activity), in collaboration with the American association of cardiovascular and pulmonary rehabilitation.Circulation. 2005; 111: 369-376https://doi.org/10.1161/01.CIR.0000151788.08740.5C
- Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase.Rev Bras Cir Cardiovasc. 2015; 30: 40-48https://doi.org/10.5935/1678-9741.20140048
- Heart Foundation.in: Rehabilitation RffC, editor. National heart foundation of Australia & Australian Cardiac Rehabilitation Association, Australia2004
- General surgical patients' experience of hospital discharge education: a qualitative study.J Clin Nurs. 2019; 29: e1-e10https://doi.org/10.1111/jocn.15057
- A periodized model for exercise improves the intra-hospital evolution of patients after myocardial revascularization: a pilot randomized controlled trial.Clin Rehabil. 2012; 26: 982-989https://doi.org/10.1177/0269215512439727
- Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European association for cardiovascular prevention & rehabilitation. Endorsed by the committee for practice guidelines of the European society of cardiology.Eur J Prev Cardiol. 2014; 21: 664-681https://doi.org/10.1177/2047487312449597
- Australian Commission on Safety and Quality in HealthCare [ACSQH]. Health literacy: taking action to improve safety and quality. 2004
- Cardiac rehabilitation in the acute care setting: integrative review.Aust Crit Care. 2017; 30: 99-106
- Nurses' role in delivering discharge education to general surgical patients: a qualitative study.J Adv Nurs. 2020; 76: 1698-1707https://doi.org/10.1111/jan.14379
- Cardiac rehabilitation and secondary prevention roundtable: Australian implementation and research priorities.Heart Lung Circ. 2020; 29: 319-323https://doi.org/10.1016/j.hlc.2020.01.001
- Cardiac rehabilitation utilization during an acute cardiac hospitalization: a national sample.J Cardpulm Rehabil Prev. 2019; 39: 19-26https://doi.org/10.1097/HCR.0000000000000374
- The impact of cardiac rehabilitation and secondary prevention programs on 12-month clinical outcomes: a linked data analysis. Heart.Lung & Circulation. 2020; 29: 475-482https://doi.org/10.1016/j.hlc.2019.03.015
- Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process.BMJ Open. 2019; 9e032279https://doi.org/10.1136/bmjopen-2019-032279
- Patient education in the management of coronary heart disease.Cochrane Database Syst Rev. 2017; 6 (PubMed PMID: CD008895)https://doi.org/10.1002/14651858.CD008895.pub3
- The integrative review: updated methodology.J Adv Nurs. 2005; 52: 546-553https://doi.org/10.1111/j.1365-2648.2005.03621.x
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71-nhttps://doi.org/10.1136/bmj.n71
- Mixed Methods Appraisal Tool (MMAT), Version 2018.Registration of copyright, 2018 (1148552:10)
- Clear and present questions: formulating questions for evidence based practice.Libr Hi Technol. 2006; 24: 355-368https://doi.org/10.1108/07378830610692127
- Decline in cardiovascular mortality: possible causes and implications.Circ Res. 2017; 120: 366-380https://doi.org/10.1161/CIRCRESAHA.116.309115
- Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription an advisory from the committee on exercise, rehabilitation, and prevention, council on clinical cardiology.Am Heart J. 2000; 101: 828-833
- Improving outcomes after acute coronary syndrome with rehabilitation and secondary prevention.Clin Therapeut. 2013; 35: 1076-1081https://doi.org/10.1016/j.clinthera.2013.07.426
- Key events in the history of cardiac surgery and paediatric cardiology.Cardiol Young. 2017; 27: 2029-2062https://doi.org/10.1017/S1047951117002256
- The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers.Educ Inf. 2018; 34: 285-291
- Engaging patients and families in communication across transitions of care: an integrative review.Patient Educ Counsel. 2020; 103: 1104-1117https://doi.org/10.1016/j.pec.2020.01.017
- The qualitative content analysis process.J Adv Nurs. 2008; 62: 107-115https://doi.org/10.1111/j.1365-2648.2007.04569.x
- Patients' experiences of and perspectives on phase 1 cardiac rehabilitation after coronary artery bypass graft surgery.Physiother Can. 2017; 69: 333-340https://doi.org/10.3138/ptc.2016-39GH
- Myocardial revascularization: strategies for coping with the disease and the surgical process.Acta Paul Enferm. 2013; 26: 8-13
- Inpatient cardiac rehabilitation programs' exercise therapy for patients undergoing cardiac surgery : national Korean Questionnaire Survey.J Exerc Rehabil. 2017; 13: 76-83https://doi.org/10.12965/jer.1732806.403
- Effects of phase I cardiac rehabilitation on anxiety of patients hospitalized for coronary artery bypass graft in Taiwan.Heart Lung. 2002; 31: 133-140
- Effects of a peer education on cardiac self-efficacy and readmissions in patients undergoing coronary artery bypass graft surgery: a randomized-controlled trial: effects of a peer education on cardiac self-efficacy and readmission in patients.Nurs Crit Care. 2017; 22: 19-28https://doi.org/10.1111/nicc.12118
- Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery - a Randomized controlled trial.Am J Phys Med Rehabil. 2008; 87: 714-719https://doi.org/10.1097/PHM.0b013e3181839152
- An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial.BMJ. 2014; 349
- Cardiac acute care nurse practitioner and 30-day readmission.J Cardiovasc Nurs. 2015; 30: 248-255
- Cardiac rehabilitation in the United States.Prog Cardiovasc Dis. 2014; 56: 522-529
- Nurses' and nurse assistants' beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit—a qualitative study.J Clin Nurs. 2017; 26: 4905-4914
- Nurse-based models for cardiovascular disease prevention from research to clinical practice.Eur J Cardiovasc Nurs. 2011; 10: S42-S50
- Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study.BMC Nurs. 2017; 16: 1-17
- Physical therapy management for adult patients undergoing cardiac surgery: a canadian practice survey.Physiother Can. 2010; 62: 215-221https://doi.org/10.3138/physio.62.3.215
- Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden.J Cardiothorac Surg. 2010; 5: 67https://doi.org/10.1186/1749-8090-5-67
- Patients' perceptions of their education needs in the first six weeks following discharge after cardiac surgery.J Adv Nurs. 1997; 25: 1241-1251https://doi.org/10.1046/j.1365-2648.1997.19970251241.x
- Sexual knowledge in patients with a myocardial infarction and their partners.J Cardiovasc Nurs. 2014; 29: 332-339
- The self-care educational intervention for patients with heart failure: a study protocol.J Cardiovasc Nurs. 2017; 32: 165-170
- Interventions to promote patient utilisation of cardiac rehabilitation.Cochrane Library. 2019; 2019CD007131-CDhttps://doi.org/10.1002/14651858.CD007131.pub4
- Discharge planning after myocardial revascularization: differences in opinions from patients and health experts.J Cardiovasc Nurs. 2016; 31: 441-444
- Important aspects in relation to patients' attendance at exercise-based cardiac rehabilitation–facilitators, barriers and physiotherapist's role: a qualitative study.BMC Cardiovasc Disord. 2017; 17: 1-10
Heartfoundation. cardiac rehabilitation. Australia.Available from: https://www.heartfoundation.org.au/getmedia/79a9855d-617c-467f-b96d-a9b2c1f0f94b/Cardiac-Rehab_Infographic-March-2021_1.pdf.
- Australian cardiovascular health and rehabilitation association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014.Heart Lung Circ. 2015; 24: 430-441https://doi.org/10.1016/j.hlc.2014.12.008
- Is there a role for cardiac rehabilitation after coronary artery bypass grafting? Treatment after coronary artery bypass surgery remains incomplete without rehabilitation.Circulation. 2016; 133: 2529-2537
- Cardiac rehabilitation and risk reduction: time to “rebrand and reinvigorate”.J Am Coll Cardiol. 2015; 65: 389-395
- Effects of acute-phase multidisciplinary rehabilitation on unplanned readmissions after cardiac surgery.J Thorac Cardiovasc Surg. 2019; https://doi.org/10.1016/j.jtcvs.2019.11.069
- Is there a role for cardiac rehabilitation after coronary artery bypass grafting?: treatment after coronary artery bypass surgery remains incomplete without rehabilitation.Circulation. 2016; 133: 2529-2537https://doi.org/10.1161/CIRCULATIONAHA.116.021348
Article info
Publication history
Published online: March 08, 2022
Accepted:
January 19,
2022
Received in revised form:
January 18,
2022
Received:
August 14,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
