The online version of this article (doi:10.1186/1471-2261-14-20) contains supplementary material, which is available to authorized users.
Hong Jin and Naifeng Liu contributed equally to this work.
The authors declare that they have no competing interest.
HJ was the principal investigator, involved in designing the study, analyzing the data, and writing the manuscript. QW and LC contributed to data collecting. HJ, QS, YZ and JW were responsible for exercise training and educational programs. NFL and GSM provided expertise in the research design and plan coordination. All authors read and approved the final manuscript.
Coronary heart disease (CHD) is a major cause of morbidity and mortality, and cardiac rehabilitation (CR) is still not well developed in mainland China. The objective of this study is to investigate the barriers associated with those seeking cardiac rehabilitation (CR) and to explore appropriate secondary prevention modalities tailored to the needs of Chinese patients with coronary heart disease (CHD).
A consecutive series of eligible patients was recruited from the cardiac department of a teaching hospital in Nanjing, located in southeast China. Structured face-to-face interviews were conducted with 328 patients prior to hospital discharge. Patient preferences for seeking an outpatient CR program or an alternative outpatient self-choice, minimal-cost educational program were evaluated. Socio-demographic characteristics and clinical data were assessed. Additionally, patients were asked to provide the reasons affecting their choice.
Overall, only 14.3% patients preferred the standard CR program. Factors associated with non-participating were female gender (odds ratios [ORs], 6.05, 95% CI, 1.30-28.19), older age (ORs, 1.11, 95% CI, 1.04-1.19, per year), less education (ORs, 8.13, 95% CI, 2.83-23.38), low income (ORs, 3.26, 95% CI, 1.24-8.54), and having either basic medical care or a lack of health insurance (ORs, 10.01, 95% CI, 3.90-25.68). The most common reason for refusing to participate in CR was that patients could not afford it. Of the remaining patients, 65.8% patients chose self-choice educational programs, especially for female (ORs, 5.84, 95% CI, 2.67-12.79), older (ORs, 1.06, 95% CI, 1.02-1.11, per year), and low income (ORs, 2.14, 95% CI, 1.12-4.10) patients. The main reasons for their preferences were their desires for more information about disease and risk factors, the low cost, feasibility, and saving time.
Multiple barriers, which may occur at the patient, health system, and societal levels, have prevented eligible patients from participating in CR programs. Self-choice educational programs, an alternative model incorporating more information, would strongly meet the needs of most patients. A feasible delivery format for secondary prevention should be provided for all CHD patients.
Niu S, Zhao D, Zhu J, Liu J, Liu Q, Liu J, Wang W, Smith SC: The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project. Am Heart J. 2009, 157 (4): 709-715. 10.1016/j.ahj.2008.12.009. e1 CrossRefPubMed
Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD, Williams MA, Lauer MS: Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005, 111 (3): 369-376. 10.1161/01.CIR.0000151788.08740.5C. CrossRefPubMed
Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N: Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004, 116 (10): 682-692. 10.1016/j.amjmed.2004.01.009. CrossRefPubMed
Witt BJ, Thomas RJ, Roger VL: Cardiac rehabilitation after myocardial infarction: a review to understand barriers to participation and potential solutions. Eura Medicophys. 2005, 41 (1): 27-34. PubMed
Jolly K, Taylor R, Lip GY, Greenfield S, Raftery J, Mant J, Lane D, Jones M, Lee KW, Stevens A: The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technol Assess. 2007, 11 (35): 1-118. CrossRefPubMed
Thompson DR, Man YC: Cardiac Rehabilitation in China. Cardiovascular Prevention and Rehabilitation. 2007, London: Springer-Verlag, 48-51. CrossRef
Ware JE, Kosinske M, Gandek B: SF-36 Health Survey: Manual and Interpretation Guide. 2003, Lincoln, RI: Quality Metric, Inc
World Health Organization: The World Health Report. 2002, 210-
Rosenfeld AG, Lindauer A, Darney BG: Understanding treatment-seeking delay in women with acute myocardial infarction: descriptions of decision-making patterns. Am J Crit Care. 2005, 14 (4): 285-293. PubMed
Bellman C, Hambraeus K, Lindback J, Lindahl B: Achievement of secondary preventive goals after acute myocardial infarction: a comparison between participants and nonparticipants in a routine patient education program in Sweden. J Cardiovasc Nurs. 2009, 24 (5): 362-368. 10.1097/JCN.0b013e3181a9bf72. CrossRefPubMed
Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van ’t Hof A, Widimsky P, Zahger D: ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012, 33 (20): 2569-2619. CrossRefPubMed
Mak YM, Chan WK, Yue CS: Barriers to participation in a phase II cardiac rehabilitation programme. Hong Kong Med J. 2005, 11 (6): 472-475. PubMed
Bethell HJ, Evans JA, Turner SC, Lewin RJ: The rise and fall of cardiac rehabilitation in the United Kingdom since 1998. J Public Health (Oxf). 2007, 29 (1): 57-61. 10.1093/pubmed/fdl091. CrossRef
- Obstacles and alternative options for cardiac rehabilitation in Nanjing, China: an exploratory study
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