Delivery methods for cardiac rehabilitation : an integrative review

Abstract

Cardiovascular disease is a major cause of death in the United States. It is estimated that over 800,000 deaths were caused by cardiovascular disease in 2006. Mortality rates have decreased since 2000, but hospital discharges associated with a cardiovascular diagnosis remained relatively constant over that same time frame. Upon discharge cardiac rehabilitation is available for individuals with cardiovascular disease. Cardiac rehabilitation is a medically prescribed program designed to aid in recovery, improve a cardiac patients' function both physically and psychologically, and prevent further cardiac complication and progression of atherosclerotic processes. However, geographic distribution of cardiac rehabilitation programs can be a barrier for program attendance. In rural areas like Montana, there could be many miles between a patient's home and a cardiac rehabilitation program. The mean geographic density for cardiac rehabilitation programs in the United States is 1 program per 1282 square miles of land area. These statistics indicate the serious potential of poor access for patients recovering from cardiac interventions in various parts of the United States. Alternative delivery methods for cardiac rehabilitation may be a solution for overcoming the geographic distribution barrier. The purpose of this integrative review was to evaluate the effectiveness of various delivery methods for cardiac rehabilitation programs on thirteen specific variables of interest related to patient outcomes. Databases were searched for empirical literature from January 2000 to August 2011, and all study design types were included in the search for literature. One reviewer selected the 49 studies used in the review, and extracted data using a standardized form. Exercise capacity and quality of life were two variables of interest found to be improved by every delivery method. A variety of delivery methods for cardiac rehabilitation were found to be as effective as center- based cardiac rehabilitation, and in most studies were significantly more effective than usual care or a control group.