Availability of, referral to and participation in exercise-based cardiac rehabilitation after heart valve surgery: Results from the national CopenHeart survey.

BACKGROUND: As with ischaemic heart disease, cardiac rehabilitation (CR) is recommended for patients undergoing heart valve surgery; recommendations are based on limited evidence. The organization of CR programmes and factors associated with uptake among patients undergoing heart valve surgery have not been studied. This study investigated CR programmes for these patients and factors associated with referral and participation. DESIGN AND METHODS: We distributed two nationwide surveys: one to 37 hospitals and 98 municipalities and one to 742 consecutive patients undergoing heart valve surgery. Data were linked to nationwide registries. We analysed the provision and content of programmes using descriptive statistics, and factors associated with referral and participation using logistic regression analysis. RESULTS: Coverage of CR programmes for these patients was high, with national programme variation. The overall uptake rate was 52%. Simultaneous CABG was associated with a higher probability of referral to CR (OR 2.02 (95%CI 1.12-3.65)); being unmarried (0.44 (0.27-0.72)) and having TAVI with a lower probability (0.26; 0.13-0.52). The referral pattern varied across administrative regions, with patients in the capital region less likely to be referred (0.22 (0.08-0.57)). Patients with TAVI were less likely to participate (0.29 (0.12-0.70)). CONCLUSIONS: Despite high national programme coverage, only half the patients post heart valve surgery received CR. Both factors identified at provider- and patient-level influenced uptake and included significant regional variation in referral pattern. Further research into the effect and organization of CR post heart valve surgery is needed.

Clinical pathways in 17 European Union countries: a purposive survey.

We undertook a survey of clinical pathways across the 25 European Union countries, Australia. Fifty-one questionnaires were completed by largely self-selected experts from 17 countries. Respondents reported that pathways were important and were becoming increasingly widely used (although the rate of progress was highly variable). One important constraint was reported to be a cultural aversion among doctors that arises at least in part from the implication that pathways require multidisciplinary teamwork which will prejudice medical autonomy. In other words, pathways challenge clinical professional sub-cultures. Other constraints included lack of encouragement by external parties, such as purchasers, with limited financial support for pathway development and implementation and service purchasing that did not reward care providers who use pathways. The obvious implication of the survey is that more needs to be done to achieve a common understanding of pathways. In spite of the large quantity of published papers, survey respondents reported that there are many health professionals who have only a superficial understanding at best.