Cardiac rehabilitation barriers among under-represented groups, and the role of targeted program model allocation

Purpose: Despite the well-established benefits of cardiac rehabilitation (CR) and greater need, under-represented populations are less likely to utilize CR compared to their counterparts. To date, there has been limited research to quantify CR barriers in these under-represented groups and there has been lack of research to assess whether barriers differ by program model. This dissertation examined CR utilization and barriers to CR use among rural and urban inhabitants, patients of low socioeconomic status (SES) and high SES, Chinese-Canadian and North American patients, and home-based versus site-based CR. Method: Cardiac patients from hospitals across Ontario, Canada completed a survey which included the Cardiac Rehabilitation Barriers Scale among other variables for this cross-sectional study. Results: Findings suggested that rural inhabitants attended significantly fewer CR sessions, and perceived greater CR barriers overall compared to urban inhabitants. These included distance, cost, and transportation problems. In addition, patients of lower SES were less likely to be referred, enroll, and participate in CR, and reported significantly greater barriers to CR compared to their high-SES counterparts. Greater barriers for low-SES patients included severe weather, distance, cost, and transportation problems. Moreover, Chinese-Canadian patients were significantly more likely to be referred to CR compared to North Americans, but there were no significant differences with regard to utilization. Chinese-Canadian patients reported significantly greater CR barriers compared to North Americans, specifically severe weather and transportation problems. Also, appropriately, home-based CR participants reported greater barriers including distance when compared to site-based participants. Conclusion: Broader application of proven strategies to promote greater CR enrolment and completion is needed, as well as development of tailored interventions to address the primary barriers identified for these vulnerable subpopulations of patients

Age Differences in Barriers to Cardiac Rehabilitation

Older patients with heart disease experience more CR barriers, and the nature of their barriers differs from those of younger patients. Health care professionals should identify and address these barriers in order to optimize the benefits of CR use for elderly patients.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Depression Screening and Treatment Recall in Male and Female Coronary Artery Disease Inpatients: Association with Symptoms One Year Later

Background: Guidelines and statements recommend cardiac patients to be screened for depression. This study examined whether cardiac inpatients recall depression screening, how the recollection varies by gender, and how it is related to depressive symptoms and treatment one year later. Methods: 2635 cardiac inpatients from 11 hospitals across Ontario, Canada completed a survey and were mailed a follow-up survey one year later. The in-hospital survey queried patients about depression screening since their cardiac diagnosis, whether they had ever been diagnosed with depression, and if yes, what treatments they were recommended. Both surveys included the Beck Depression Inventory-II (BDI-II)to assess depressive symptoms. Results: Of the 1809 (68.7%) retained participants, 513 (30.0%) participants recalled depression screening and they were significantly more likely to be male. Screening recall was not significantly related to depressive symptoms at both time points(P>0.05). Participants who were recommended anti depressants had higher BDI-II scores than those who were not recommended antidepressants, both as inpatients (P 0.05).Conclusion: Less than one-third of cardiac inpatients recalled being screened for depression. Recall of screening was not significantly related to depressive symptoms, and use of treatment was related to greater symptoms. Improved patient-provider communication regarding depression screening in cardiac patients is warranted, as well as better monitoring of treatment response in clinical practice

Autogestion des troubles de l'humeur et/ou d'anxiété par l'activité physique et l'exercice

Introduction : L'activité physique et l'exercice constituent une stratégie d'autogestion importante pour les personnes vivant avec une maladie mentale. Cette étude visait à caractériser à la fois les personnes atteintes d'un trouble de l'humeur et/ou d'anxiété qui faisaient de l'exercice ou de l'activité physique pour aider à gérer leur trouble et celles qui n'en faisaient pas, ainsi qu'à identifier les facteurs facilitant l'activité physique et l'exercice et ceux constituant un obstacle. Méthodologie : L'Enquête sur les personnes ayant une maladie chronique au Canada - Composante des troubles de l'humeur et/ou d'anxiété de 2014 a été utilisée pour cette étude. Les répondants (n = 2 678) ont été classés en fonction de la fréquence à laquelle ils faisaient de l'exercice : (1) aucun exercice, (2) exercice une à trois fois par semaine et (3) exercice quatre fois ou plus par semaine. Nous avons procédé à des analyses descriptives et de régression logistique multinomiale. Nous avons pondéré toutes les estimations afin que les données soient représentatives de la population canadienne adulte vivant en logement privé dans l'une des 10 provinces et ayant déclaré avoir reçu un diagnostic de troubles de l'humeur et/ou d'anxiété. Résultats : Sur l'ensemble des Canadiens affectés, 51,0 % ne faisaient aucun exercice pour aider à gérer leur trouble de l'humeur et/ou d'anxiété, 23,8 % en faisaient d'une à trois fois par semaine et 25,3 % en faisaient quatre fois ou plus par semaine. On a établi un lien entre, d'une part, un âge plus avancé, des niveaux de scolarité plus bas et une suffisance de revenu du ménage plus faible et, d'autre part, une fréquence plus importante de l'inactivité. Les individus vivant avec un trouble de l'humeur (avec ou sans anxiété) et ceux avec des comorbidités physiques étaient moins susceptibles de faire régulièrement de l'exercice. Les recommandations d'un médecin ou d'un autre professionnel de la santé constituaient le facteur le plus important associé à la décision de faire de l'exercice. Les obstacles mentionnés le plus souvent à de l'exercice au moins une fois par semaine étaient un problème physique (27,3 %), un manque de temps ou un horaire trop chargé (24,1 %) et un manque de volonté ou d'autodiscipline (15,8 %). Conclusion : Malgré les bénéfices de l'activité physique et de l'exercice pour contrer les symptômes de dépression et d'anxiété, un pourcentage important de personnes atteintes d'un trouble de l'humeur et/ou d'anxiété ne fait aucun exercice sur une base régulière, particulièrement celles atteintes de trouble de l'humeur et celles présentant des comorbidités physiques. Il est essentiel que les professionnels de la santé recommandent à leurs patients de faire une activité physique ou de l'exercice, discutent avec eux des obstacles rencontrés et les encouragent à persévérer

Self-management of mood and/or anxiety disorders through physical activity/exercise

Introduction: Physical activity/exercise is regarded as an important self-management strategy for individuals with mental illness. The purpose of this study was to describe individuals with mood and/or anxiety disorders who were exercising or engaging in physical activity to help manage their disorders versus those who were not, and the facilitators for and barriers to engaging in physical activity/exercise. Methods: For this study, we used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. Selected respondents (n = 2678) were classified according to the frequency with which they exercised: (1) did not exercise; (2) exercised 1 to 3 times a week; or (3) exercised 4 or more times a week. We performed descriptive and multinomial multiple logistic regression analyses. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. Results: While 51.0% of the Canadians affected were not exercising to help manage their mood and/or anxiety disorders, 23.8% were exercising from 1 to 3 times a week, and 25.3% were exercising 4 or more times a week. Increasing age and decreasing levels of education and household income adequacy were associated with increasing prevalence of physical inactivity. Individuals with a mood disorder (with or without anxiety) and those with physical comorbidities were less likely to exercise regularly. The most important factor associated with engaging in physical activity/exercise was to have received advice to do so by a physician or other health professional. The most frequently cited barriers for not exercising at least once a week were as follows: prevented by physical condition (27.3%), time constraints/too busy (24.1%) and lack of will power/self-discipline (15.8%). Conclusion: Even though physical activity/exercise has been shown beneficial for depression and anxiety symptoms, a large proportion of those with mood and/or anxiety disorders did not exercise regularly, particularly those affected by mood disorders and those with physical comorbidities. It is essential that health professionals recommend physical activity/exercise to their patients, discuss barriers and support their engagement

Cardiac Rehabilitation Services in Low-and Middle-Income Countries: A Scoping Review

Background: Despite the decreasing rate of cardiovascular disease-related mortality in developed nations, low-and middle-income countries (LMICs) are experiencing an increase. Cardiac rehabilitation (CR) successfully addresses this burden, however the availability and nature of CR service delivery in LMICs is not well-known. Objective: This scoping review examined: (1) presence and accessibility of CR services, (2) structure of CR services, and (3) effects of CR on patient outcomes in LMICs. Methods: Search criteria consisted of: (1) nations considered to be low-or middle-income according to World Bank criteria, (2) CR, defined as programs including exercise and education, and (3) adults with cardiovascular diseases. Literature was identified through searching: (a) MEDLINE and EMBASE electronic databases, (b) proceedings from international cardiac conferences, (c) the grey literature, and (d) through consulting experts in the field. Results: Thirty peer-reviewed publications were identified. Grey literature including websites for individual CR programs revealed that CR is available in 32 (22.1%) LMICs. The most comprehensive data on accessibility stems from Latin America and the Caribbean, where56% of institutions with cardiac catheterization facilities offered CR. Literature showed that some programs offered exercise, dietary advice, education and psychological support, to assist patients to resume work and other activities of daily living. Fifteen peer-reviewed studies reported on CR outcomes; most of which were positive. Conclusion: Although patients similarly benefit from CR, few programs are available in LMICs. Policies need to be implemented to increase provision of tailored CR models at the global and national level, with evaluation

A comparison of barriers to use of home versus site-based cardiac rehabilitation

Purpose: Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. It is unknown whether patient barriers to enrollment and adherence are addressed by offering choice of program type. The purpose of this study was to examine barriers to participation in CR by program type (site vs. home-based), and the relation of these barriers to degree of program participation and exercise behavior. Method: 1809 cardiac patients from 11 hospitals across Ontario completed a sociodemographic survey in-hospital, and clinical data were extracted from charts. They were mailed a follow-up survey one year later, which included the Cardiac Rehabilitation Barriers Scale and the Physical Activity Scale for the Elderly. Participants were also asked whether they attended CR, the type of program model attended, and the percentage of prescribed sessions completed. Results: Overall, 939 (51.9%) patients participated in CR, with 96 (10.3%) participating in a home-based program. Home-based participants reported significantly greater CR barriers compared to site-based participants (p0.05). Conclusion: The barriers to CR are significantly different among patients attending site vs. home-based program, suggesting appropriate use of alternative models of care. Patient preferences should be considered when allocating patients to program models. Once in CR, programs should work towards identifying and tackling barriers among site-based participants. Abstract word count=231This study was funded by Canadian Institutes of Health Research (CIHR) and Heart and Stroke Foundation of Canada grant #HOA-80676. Ms. Shanmugasegaram is supported in her graduate studies by the CIHR Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award. In addition, Dr. Grace is supported by CIHR salary award #MSH-80489

Screening for depression in women during pregnancy or the first year postpartum and in the general adult population: a protocol for two systematic reviews to update a guideline of the Canadian Task Force on Preventive Health Care

Abstract Background In 2018, the World Health Organization reported that depression is the most common cause of disability worldwide, with over 300 million people currently living with depression. Depression affects an individual’s physical health and well-being, impacts psychosocial functioning, and has specific negative short- and long-term effects on maternal health, child health, developmental trajectories, and family health. The aim of these reviews is to identify evidence on the benefits and harms of screening for depression in the general adult population and in pregnant and postpartum women. Methods Search strategies were developed and tested through an iterative process by an experienced medical information specialist in consultation with the review team. We will search MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library, and a randomized controlled trial filter will be used. The general adult review will be an update of a systematic review previously used by the Canadian Task Force on Preventive Health Care for their 2013 guideline recommendation. The search strategy will be updated and will start from the last search date of the previous review (May 2012). The pregnant and postpartum review will be a de novo review with no date restriction. For both reviews, we will search for unpublished documents following the CADTH Grey Matters checklist and relevant websites. Titles and abstracts will be screened using the liberal accelerated method. Two reviewers will independently screen full-text articles for relevance using pre-specified eligibility criteria and assess the risk of bias of included studies using the Cochrane Risk of Bias tool. Outcomes of interest for the general adult population review include symptoms of depression or diagnosis of major depressive disorder, health-related quality of life, day-to-day functionality, lost time at work/school, impact on lifestyle behaviour, suicidality, false-positive result, labelling/stigma, overdiagnosis or overtreatment, and harms of treatment. Outcomes of interest for the pregnant and postpartum review include mental health outcomes (e.g. diagnosis of major depressive disorder), parenting outcomes (e.g. mother-child interactions), and infant outcomes (e.g. infant health and development). Discussion These two systematic reviews will offer informative evaluations of depression screening. The findings will be used by the Task Force to help develop guideline recommendations on depression screening in the general adult population and in pregnant and postpartum women in Canada. Systematic review registration PROSPERO (CRD42018099689, CRD42018099690