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Recent Submissions

ItemOpen Access
Adapted Motivational Interviewing to Promote Exercise in Adolescents With Congenital Heart Disease: A Pilot Trial
(Lippincott, Williams & Wilkins, 2018-10) McKillop, Adam; Grace, Sherry; Lima de Melo Ghisi, Gabriela; Allison, Kenneth; Banks, Laura; Kovacs, Adrienne H.; Schneiderman, Jane; McCrindle, Brian
Purpose: To assess a motivational interviewing (MI) intervention to improve moderateto-vigorous physical activity (MVPA) in adolescents with congenital heart disease. Design: Pilot randomized controlled trial. Methods: Intervention participants received one-on-one telephone-based adapted MI sessions over 3 months. Outcomes were acceptability, change mechanisms (stage of change and self-efficacy), and limitedefficacy (PA, fitness and quality of life). Findings: 36 (66.7%) patients (50.0% male; 15.1±1.5 years) were randomized. Intervention participants completed 4.2±1.2/6 MI sessions, with no improvements in the high self-efficacy or stage of change observed (p>0.05). Overall, participants accumulated 47.24±16.36 minutes of MVPA/day, and had comparable outcomes to healthy peers (except for functional capacity). There was no significant difference in change in any outcome by group. Conclusions: The intervention was acceptable, but effectiveness could not be determined due to the nature and size of sample. Clinical Relevance: Pediatric cardiac rehabilitation remains the sole effective intervention to increase MVPA in this population.
ItemOpen Access
Perceptions of cardiology administrators about cardiac rehabilitation in South America and the Caribbean
(Lippincott, Williams & Wilkins, 2017-07) Lima de Melo Ghisi, Gabriela; Britto, Raquel; Servio, Thaianne Cavalcante; ANCHIQUE SANTOS, CLAUDIA VICTORIA; Fernandez, Rosalia; Rivas Estany, Eduardo; Santibañez, Claudio; GONZALEZ, GRACIELA; Burdiat, Gerard; Lopez-Jimenez, Francisco; HADDAD HERDY, ARTUR; Grace, Sherry
Background: Cardiac rehabilitation (CR) programs can address the cardiovascular disease epidemic in South America. However, there are factors limiting CR access at the patient, provider, and system levels. The latter 2 have not been extensively studied. The objective of this study was to investigate cardiology administrator's awareness and knowledge of CR and perceptions regarding resources for CR. Methods: This study was cross-sectional and observational in design. Cardiology administrators from South American and Caribbean countries were invited to participate by members of a professional association. Participants completed a questionnaire online. Descriptive analysis was performed and differences in CR knowledge, awareness, perception, and attitudes regarding CR were described overall, by institution funding source (private vs public) and presence of within-institution CR (yes vs no). Results: Most of the 55 respondents from 8 countries perceived CR as important for outpatient care (mean ± SD = 4.83 ± 0.38 out of 5; higher scores indicating more positive perceptions), with benefits including reduced hospital readmissions (4.31 ± 0.48) and length of stay (4.64 ± 0.71 days), not only for cardiac patients but for those with other vascular conditions (4.34 ± 0.68 days). Those working in public institutions (50.9%) and in institutions without a CR program (25.0%) were not as aware of, and less likely to value, CR services (P < .05). Only 13.2% of programs had dedicated funding. Conclusions: Similar to findings from high-income settings, cardiology administrators and cardiologists in South America value CR as part of cardiac patient care, but funding and availability of programs restrict capacity to deliver these services.
ItemOpen Access
Interventions Supporting Long-term Adherence and Decreasingcardiovascularevents(ISLAND): Pragmatic randomized trial protocol
(Elsevier, 2017-06-03) Ivers, Noah; Witteman, Holly; Presseau, Justin; Taljaard, Monica; McCready, Tara; Bosiak, Beth; Cunningham, Jennifer; Smarz, Shelley; Desveaux, Laura; Tu, Jack V.; Atzema, Clare; Oakes, Garth; Isaranuwatchai, Wanrudee; Grace, Sherry; Bhatia, R Sacha; Natarajan, Madhu Kailash; Grimshaw, Jeremy
Background Guidelines recommend cardiac rehabilitation (CR) and long-term use of cardiac medications for most patients who have had a myocardial infarction (MI), but adherence to these secondary prevention treatments is sub-optimal. Methods/Design This is a multi-center, pragmatic, three-arm randomized trial. Eligible patients are randomized postMI to usual care or one of two intervention arms. Patients in the first intervention arm receive mailouts sent on behalf of their cardiologist at 4, 8, 20, 32, and 44 weeks post-MI; content is designed to address determinants of adherence, and facilitate discussion between the patient and their health care team. Patients in the second intervention arm receive mail-outs plus automated interactive voice response system (IVRS) phone calls 2 weeks after each letter, as well as a telephone call by trained lay health workers if the IVRS identifies challenges with adherence. Outcomes are assessed 12 months post-MI via patient self-report and administrative data sources. Co-primary outcomes are adherence to cardiac medications and completion of CR. Secondary outcomes include cardiovascular events and mortality. An embedded, theory-informed process evaluation will explore the mechanism of action; an economic evaluation is also planned. Discussion We describe a complete program evaluation of a highly pragmatic, health-system intervention to support adherence to recommended treatments. Research ethics boards approved waiver of consent for patients enrolled in the trial with provision of multiple opportunities to opt-out and a debrief at the time of outcome assessment. The methods used here may provide a model for similar interventions.
ItemOpen Access
Cardiac Rehabilitation Following Acute Coronary Syndrome in Women
(Springer, 2017-06-17) Bennett, Amanda L.; Lavie, Carl; Grace, Sherry
Opinion statement Acute coronary syndrome (ACS) is among the leading burdens of disease among women. It is a significant driver of morbidity and chronically undermines their quality of life. Cardiac rehabilitation (CR) is indicated for ACS patients in clinical practice guidelines, including those specifically for women. CR is a multi-component model of care, proven to reduce mortality and morbidity, including in women. However, women are significantly less likely to be referred to CR by providers, and if they are referred, to enroll and adhere to programs. Reasons include lack of physician encouragement, preference not to feel fatigue and pain, transportation barriers, comorbidities and caregiving obligations. Strategies to mitigate this under-use include systematic early inpatient referral, tailoring programs to meet women’sneedsand preferences (e.g., offering dance, opportunities for social interaction), and offering nonsupervised delivery models. Unfortunately, these strategies are not widely available to women. Given the greater longevity seen in women, the critical role CR plays in augmenting quality of life in this population must be recognized and care providers must do more to facilitate referral to and encourage participating in CR programs.
ItemOpen Access
A Review of Cardiac Rehabilitation Delivery Around the World
(Elsevier, 2017-10-13) Pesah, Ella; Supervia, Marta; Turk-Adawi, Karam; Grace, Sherry
Herein, 28 publications describing cardiac rehabilitation (CR) delivery in 50 of the 113 countries globally suspected to deliver it are reviewed, to characterize the nature of services. Government funding was the main source of CR reimbursement in most countries (73%), with private and patient funding in about ¼ of cases. Myocardial infarction patients and those having revascularization were commonly served. The main professions delivering CR were physicians, nurses, and physiotherapists. Programs offered a median of 20 sessions, although this varied. Most programs offered the core components of exercise training, patient education and nutrition counselling. Alternative models were not commonly offered. Lack of human and/or financial resources as well as space constraints were reported as the major barriers to delivery. Overall, CR delivery has been characterized in less than half of the countries where it is offered. The nature of services delivered is fairly consistent with major CR guidelines and statements.