Finalising an item bank for a first draft cardiac rehabilitation PROM

Background: A Scotland-wide scoping exercise identified the need for a new patient-reported outcome measure (PROM) to suit the range of diagnostic groups now accessing cardiac rehabilitation (CR). A previous literature review of existing tools guided a qualitative methodology involving CR staff and service users (Cowie et al, 2018). Aim: This paper describes the merging of literature review findings with qualitative data to finalise the item bank for a first draft tool (PROM-CR1). Methods: Conceptual ideas identified from existing tools were aligned with key themes and subthemes within the qualitative data. Quotes most reflective of the qualitative language were used to evidence themes and develop 40 construct indicators which were used to build PROM-CR1. Results: PROM-CR1 contains 40 items across 'physical', 'social', 'psychological' and 'therapeutic' domains, plus 'general health and well-being', 'physical', 'social', and 'psychological' summary scores. Future directions: PROM-CR1 will be piloted with both staff and service users, and refined to develop a finalised tool (PROM-CR) for clinical practice

Developing an initial item bank for a new cardiac rehabilitation PROM

Background: A Scotland-wide government scoping exercise identified the need for a new patient-reported outcome measure (PROM) suitable for the wide range of diagnostic groups now accessing cardiac rehabilitation (CR). Aim: This paper describes the initial steps underpinning development of the item bank for a first draft tool (PROM–CR1). Methods: A literature review of existing tools was undertaken to guide a qualitative data collection methodology involving 19 CR staff and 22 service users. Results: Four conceptual ideas for health/quality of life were identified from the literature review: general health; physical; social; and psychological. Three key qualitative themes, largely reflective of literature review findings, were identified: expectations and entitlement; adjustment and acceptance; and control and choice. Future directions: These data will be combined to form PROM-CR1’s initial item bank, which will be piloted with staff and service users and refined to generate a finalised tool (PROM–CR) for use in clinical practice

Living with myocardial ischaemia and no obstructive coronary arteries: a qualitative study

Objective To explore the lived experience of people with myocardial ischaemia with no obstructive arteries. Design Qualitative study using semistructured interviews. Setting Telephone interviews with 17 participants living in the UK. Participants 17 people (2 males, 15 females; aged 31–69 years) with a presumed or confirmed diagnosis of myocardial ischaemia with no obstructive arteries, recruited via social media and online patient-led support forums. Results Five themes were generated. Theme 1 describes the wide range of experiences that participants described, particularly the frequency and intensity of symptoms, and the uncertainty and fear that symptoms commonly provoked. Theme 2 describes the major impact on social relationships, employment and other aspects of everyday life. Theme 3 illustrates challenging and traumatising experiences participants described around pathways to diagnosis and accessing medical support. Theme 4 highlights the lack of consensus and clarity that participants had been confronted with around treatment and management. Theme 5 describes coping and supportive strategies valued by participants. Conclusions This study provides insight into the challenges of living with myocardial ischaemia with no obstructive arteries. Findings highlight the significant psychological impact on people living with these conditions and the need for improvements in diagnosis, support and long-term management

How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR

Objective To investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation. Design A mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety. Setting International survey of exercise-based cardiac rehabilitation programmes. Participants Healthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide. Main outcome measures The proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation. Results Three hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing. Conclusions The rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to highrisk patients, may be needed

Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study)

Aims Alternative models of cardiac rehabilitation (CR) are required to improve CR access and uptake. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a comprehensive home-based rehabilitation and self-management programme, facilitated by trained health professionals, for people with heart failure (HF) and their caregivers. REACH-HF was shown to be clinically effective and cost-effective in a multicentre randomised trial. The SCOT:REACH-HF study assessed implementation of REACH-HF in routine clinical practice in NHS Scotland. Methods & results A mixed-method implementation study was conducted across six regional Health Boards. Of 136 people with HF and 56 caregivers recruited, 101 people with HF and 26 caregivers provided four-month follow-up data, after participating in the 12-week programme. Compared with baseline, REACH-HF participation resulted in substantial gains in the primary outcome of health-related quality of life, as assessed by the Minnesota Living with Heart Failure Questionnaire (mean difference: -9.8, 95% CI: -13.2 to -6.4, P < 0.001). Improvements were also seen in secondary outcomes (PROM-CR+; EQ-5D-5L; Self-Care of Heart Failure Index (SCHFI) domains of maintenance and symptom perception; Caregiver Contribution to Self-Care (CC-SCHFI) domains of symptom perception and management). Twenty qualitative interviews were conducted with 11 REACH-HF facilitators, five supporting clinicians, and four national stakeholders. Interviewees were largely positive about REACH-HF, considering it to have ‘filled a gap’ where centre-based CR was not an option. Key issues to support future roll-out were also identified. Conclusion Our findings support wider roll-out of REACH-HF as an alternative to centre-based models, to improve CR access and uptake for people with HF

Research priorities relating to the delivery of cardiovascular prevention and rehabilitation programmes: results of a modified Delphi process

Objective: The purpose of this British Association for Cardiovascular Prevention and Rehabilitation (BACPR) research priority setting project (PSP) was to identify a top 10 list of priority research questions for cardiovascular prevention and rehabilitation (CVPR). Methods: The PSP was facilitated by the BACPR clinical study group (CSG), which integrates as part of the British Heart Foundation Clinical Research Collaborative. Following a literature review to identify unanswered research questions, modified Delphi methods were used to engage CVPR-informed expert stakeholders, patients, partners and conference delegates in ranking the relevance of research questions during three rounds of an anonymous e-survey. In the first survey, unanswered questions from the literature review were ranked and respondents proposed additional questions. In the second survey, these new questions were ranked. Prioritised questions from surveys 1 and 2 were incorporated in a third/final e-survey used to identify the top 10 list. Results: From 459 responses across the global CVPR community, a final top 10 list of questions were distilled from an overall bank of 76 (61 from the current evidence base and a further 15 from respondents). These were grouped across five broad categories: access and remote delivery, exercise and physical activity, optimising programme outcomes, psychosocial health and impact of the pandemic. Conclusions: This PSP used a modified Delphi methodology to engage the international CVPR community to generate a top 10 list of research priorities within the field. These prioritised questions will directly inform future national and international CVPR research supported by the BACPR CSG