Cochrane corner: increasing patient utilisation of cardiac rehabilitation

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). 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, …