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Cochrane corner: increasing patient utilisation of cardiac rehabilitation
  1. Carolina Santiago de Araújo Pio1,
  2. Gabriela Chaves2,
  3. Philippa Davies3,
  4. Rod Taylor4,5,
  5. Sherry L Grace1,6
  1. 1 Faculty of Health, York University, Toronto, Ontario, Canada
  2. 2 Rehabilitation Science Program, Federal University of Minas Gerais, Belo Horizonte, Brazil
  3. 3 School of Social and Community Medicine, University of Bristol, Bristol, UK
  4. 4 Institute of Health Research, University of Exeter Medical School, Exeter, UK
  5. 5 Institute of Health and Well Being, University of Glasgow, Glasgow, UK
  6. 6 KITE-Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Sherry L Grace, Faculty of Health, York University, Toronto, Ontario M3J 1P3, Canada; sgrace{at}

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Cardiac rehabilitation (CR) is an outpatient chronic disease management programme to optimise patient recovery and prevent further cardiac events. Programmes offer core components to optimise cardiovascular risk reduction, foster healthy behaviours (eg, exercise, healthy eating, tobacco cessation), increase patients’ understanding of their disease and improve psychosocial well-being. CR has been shown to improve health-related quality of life, as well as decrease subsequent morbidity and cardiovascular mortality by approximately 20%.1 As a result, CR is an integral recommendation in many clinical guidelines for secondary prevention in cardiac patients.2

However, CR utilisation remains suboptimal. Such underutilisation can be attributed in part to low referral by healthcare providers. However, even among patients referred, few enrol in CR, and many of those who do drop out.3 Factors impacting utilisation of CR include distance, financial resources, work and other time constraints, gender, age, social support, illness perceptions, and depression.4

Here we highlight the updated systematic review and meta-analysis of interventions to increase patient utilisation of CR.5 Utilisation was operationalised as enrolment (ie, patient attendance at a first visit), adherence (ie, percentage of prescribed sessions completed) and completion (ie, patients attended at least some of the programme and had a formal reassessment by staff at the end of the programme) of CR.6 Harms, costs and equity were also considered (secondary outcomes).

Review methods

A search was performed through July 2018 to identify trials published since the previous systematic review. The Cochrane Library, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, EBSCOhost and Conference Proceedings Citation Index, among other databases, were searched. The reference lists of relevant systematic reviews were hand-searched for additional trials, and two clinical trial registers were also searched.

Randomised controlled trials in adults with myocardial infarction, angina, undergoing coronary artery bypass graft surgery or percutaneous coronary intervention, …

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  • Contributors CSdAP was responsible for the literature review/study selection, hand-searching the literature, data extraction from included studies, meta-analysis of data, risk of bias assessment, GRADE, generating the summary of findings table and updating the results in the review (text and display items). GC was responsible for literature review/study selection, data extraction, risk of bias assessment and initial analysis of data. PD was responsible for the design of the previous versions of the review, reviewing GRADE, critically revising the manuscript for important intellectual content and final approval of the review. RT was responsible for the design of the previous versions of the review, meta-regression analysis, critically revising the manuscript for important intellectual content and final approval of the review. SLG was responsible for coordinating the update, updating the study methods, resolving abstract and full-text conflicts, interpretation of data, updating the review content text and final approval of the review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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