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Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement.

  • Santiago de Araújo Pio, Carolina1
  • Beckie, Theresa M2
  • Varnfield, Marlien3
  • Sarrafzadegan, Nizal4
  • Babu, Abraham S5
  • Baidya, Sumana6
  • Buckley, John7
  • Chen, Ssu-Yuan8
  • Gagliardi, Anna9
  • Heine, Martin10
  • Khiong, Jong Seng11
  • Mola, Ana12
  • Radi, Basuni13
  • Supervia, Marta14
  • Trani, Maria R15
  • Abreu, Ana16
  • Sawdon, John A17
  • Moffatt, Paul D18
  • Grace, Sherry L19
  • 1 School of Kinesiology and Health Science, York University, Toronto, Canada. , (Canada)
  • 2 College of Nursing, University of South Florida, Tampa, USA.
  • 3 Australian eHealth Research Centre, CSIRO, and Australian Cardiovascular Health and Rehabilitation Association (ACRA), Australia. , (Australia)
  • 4 Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, Canada; Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. , (Canada)
  • 5 Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India. , (India)
  • 6 Kathmandu University, Dhulikhel Hospital, Dhulikhel, Nepal. , (Nepal)
  • 7 Centre for Active Living, University Centre Shrewsbury, Shrewsbury, UK.
  • 8 Department of Physical Medicine & Rehabilitation, Fu Jen Catholic University Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. , (Taiwan)
  • 9 Toronto General Hospital Research Institute, University Health Network, Toronto, Canada. , (Canada)
  • 10 Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. , (South Africa)
  • 11 Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam. , (Brunei)
  • 12 Rehabilitation Medicine, New York University School of Medicine, New York City, NY, USA.
  • 13 National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. , (Indonesia)
  • 14 Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo, 46, 28007 Madrid, Spain; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, MN, USA. , (Spain)
  • 15 Council of Cardiac Rehabilitation and Sports Cardiology, Philippine Heart Association, Pasig City, Philippines and Section of Cardiology, Chong Hua Hospital Heart Institute, Cebu City, Philippines. , (Philippines)
  • 16 Cardiology Department, Hospital Santa Maria, CHLN, Lisbon, Portugal; Medical School of University of Lisbon, Lisbon, Portugal. , (Portugal)
  • 17 Public Education and Special Projects, Cardiac Health Foundation of Canada, Toronto, Canada. , (Canada)
  • 18 Patient Partner Program, University Health Network, Toronto, Canada. , (Canada)
  • 19 School of Kinesiology and Health Science, York University, Toronto, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada. Electronic address: [email protected] , (Canada)
Published Article
International journal of cardiology
Publication Date
Jan 01, 2020
DOI: 10.1016/j.ijcard.2019.06.064
PMID: 31405584


Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95 ± 0.69 (mean ± standard deviation), 5.33 ± 1.12 and 5.64 ± 1.08, respectively. Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs. Copyright © 2019. Published by Elsevier B.V.

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