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Abstract
Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion.
Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study.
Setting: Economically disadvantaged areas in rural Australia.
Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.
Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28).
Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion.
Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.
Original language | English |
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Pages (from-to) | 837-854 |
Number of pages | 18 |
Journal | Clinical Rehabilitation |
Volume | 38 |
Issue number | 6 |
Early online date | 17 Apr 2024 |
DOIs | |
Publication status | Published - Jun 2024 |
Keywords
- cardiac rehabilitation
- Cardiovascular disease
- low socioeconomic status
- morbidity and mortality
- rural populations
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Dive into the research topics of 'Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study'. Together they form a unique fingerprint.Prizes
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A winner of the Big Ideas video competition to improve the Australian health system. Consumer Health Forum of Australia, 2021.
Pinero de Plaza, A. (Recipient), 23 Feb 2021
Prize: Other distinction
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Consumers' Choice Poster - Sponsored by The Heart Foundation
Beleigoli, A. (Recipient), Gebremichael, L. (Recipient), Bulamu, N. B. (Recipient), Nesbitt, K. (Recipient), Foote, J. (Recipient), Powell, S. (Recipient), Ramos, J. (Recipient), Suebkinorn, O. (Recipient), Pinero de Plaza, M. A. (Recipient), Kaambwa, B. (Recipient) & Clark, R. (Recipient), 17 Nov 2023
Prize
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Activities
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A Human-Machine Evaluation of AI in Cardiac Emergencies
Pinero de Plaza, M. A. (Invited speaker), Lambrakis, K. (Speaker), Marmolejo-Ramos, F. (Speaker), Beleigoli, A. (Speaker), Kitson, A. (Speaker), McMillan, P. (Speaker), Chew, D. (Speaker), Clark, R. (Speaker), Lawless, M. (Speaker), Morton, E. (Speaker), Archibald, M. (Speaker), Visvanathan, R. (Speaker), Yadav, L. (Speaker), Hendriks, J. (Speaker) & Javier Barrera Causil, C. (Speaker)
11 Jun 2024Activity: Talk or presentation types › Invited talk
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PROLIFERATE_AI: Leading the Future of Innovation with AI, Predictive Modelling, and Ethical User-Centred Design
Pinero de Plaza, M. A. (Consultant), Marmolejo Ramos, F. (Consultant), Lambrakis, K. (Advisor), Beleigoli, A. (Consultant), Morton, E. (Consultant), Archibald, M. (Advisor), Lawless, M. (Advisor), McMillan, P. (Advisor), Ambagtsheer, R. C. (Advisor), Mudd, A. (Consultant), Yadav, L. (Consultant), Clark, R. (Advisor), Visvanathan, R. (Advisor), Chipchase, L. (Advisor), Jacobs, D. (Advisor), Hendriks, J. (Consultant), Javier Barrera Causil, C. (Consultant), Chew, D. (Advisor) & Kitson, A. (Consultant)
2024 → 2045Activity: Consultancy types › Consultancy
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How can research, advocacy, and innovation come together to improve digital health for better care?
Pinero de Plaza, M. A. (Speaker)
23 May 2023Activity: Talk or presentation types › Invited talk
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Care biography: A concept analysis
Tieu, M., Cussó, R., Collier, A., Cochrane, T., Pinero de Plaza, M. A., Lawless, M., Feo, R., Perimal-Lewis, L., Thamm, C., Hendriks, J. M., Lee, J., George, S., Laver, K. & Kitson, A., Jul 2024, In: Nursing Philosophy. 25, 3, 14 p., e12489.Research output: Contribution to journal › Article › peer-review
Open AccessFile1 Citation (Scopus)29 Downloads (Pure) -
Clinical Effectiveness and Implementation Evaluation of a Large-Scale Translation Co-Designed Model on Cardiac Rehabilitation Attendance and Completion in Rural Australia Authors
Beleigoli, A., Gebremichael, L., Bulamu, N., Gulyani, A., Chew, D., Nicholls, S., Ramos, J., Maher, C., Beltrame, J., Kaambwa, B., Versace, V., Hendriks, J., Tavella, R., Foote, J., Nesbitt, K., Powell, S., Pinero de Plaza, M., Keech, W., Ludlow, M. & Maeder, A. & 7 others, , Aug 2024, In: Heart Lung and Circulation. 33, Supplement 4, p. S226-S227 2 p.Research output: Contribution to journal › Meeting Abstract › peer-review
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Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)
Beleigoli, A., Foote, J., Gebremichael, L. G., Bulamu, N. B., Astley, C., Keech, W., Tavella, R., Gulyani, A., Nesbitt, K., Pinero de Plaza, M. A., Ramos, J. S., Ludlow, M., Nicholls, S. J., Chew, D. P., Beltrame, J. & Clark, R. A., Jul 2024, In: Heart Lung and Circulation. 33, 7, p. 1036-1045 10 p.Research output: Contribution to journal › Article › peer-review
Open AccessFile2 Citations (Scopus)46 Downloads (Pure)