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Clinical determinants and barriers to cardiac rehabilitation enrolment of heart failure patients
Session:
Posters (Sessão 1 - Écran 4) - Insuficiência Cardíaca 1 - Vários 1
Speaker:
André Filipe Macedo Alexandre
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
André Alexandre; Andreia Campinas; Cristine Schmidt; Sandra Magalhães; José Preza-Fernandes; João Silveira; Catarina Gomes; Mário Santos; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Introduction</span></u><span style="font-family:"Times New Roman",serif">: Cardiac rehabilitation (CR) is a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF). Despite the robust evidence supporting its safety and benefits, there is an incomplete understanding of the reasons of the underutilization of CR programs in HFrEF. These reasons are complex and probably encompass healthcare system- and patient-level barriers.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Aim</span></u><span style="font-family:"Times New Roman",serif">: To study the clinical determinants and barriers to enrolment in a CR program for HFrEF patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Methods</span></u><span style="font-family:"Times New Roman",serif">: We conducted a study of consecutive heart failure patients followed at a dedicated HFrEF cardiology clinic from January 2019 to April 2021. Patients were divided according to previous enrolment in CR program. Data were collected from electronic health records, and in case of missing data patients were asked by telephone about the reason for not participating in CR using a structured and validated questionnaire for this purpose.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Results</span></u><span style="font-family:"Times New Roman",serif">: Of 228 patients with HFrEF, 60% had not been enrolled in a CR program; they were older (63 vs 58 years; p<0.01) and more likely to have comorbidities such as hypertension (56% vs 41%; p=0.03) or concomitant chronic obstructive pulmonary disease (20% vs 8%; p=0.01). Conversely, patients enrolled in CR programs were more likely to have a previous history of acute myocardial infarction (34% vs 20%; p=0.02). Regarding heart failure-related clinical features (NYHA functional class, LVEF, ICD/CRT), we did not find any significant differences between groups. The main reasons for not being enrolled in CR programs were: no medical referral (31%), concomitant medical problems (27%) such as musculoskeletal problems, patient refusal (11%) and geographical distance to the hospital (9%).</span></span></span></p> <p><u><span style="font-size:11.0pt"><span style="font-family:"Times New Roman",serif">Conclusion</span></span></u><span style="font-size:11.0pt"><span style="font-family:"Times New Roman",serif">: Despite the high proportion (40%) of HFrEF patients who underwent CR program compared to previous studies, the enrolment to CR can be further improved. The main barriers are related to health professionals (no referral), healthcare system (geographical distance to the hospital) and patients (concomitant noncardiac problems). Innovative strategies should target these factors to increase the delivery of CR program in HFrEF.</span></span></p>
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