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Abstract：
OBJECTIVE: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion.
METHODS: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study.
METHODS: Economically disadvantaged areas in rural Australia.
METHODS: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.
METHODS: 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.
METHODS: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study.
METHODS: Economically disadvantaged areas in rural Australia.
METHODS: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.
METHODS: 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.
摘要：
目的：研究心脏康复的应用和效果，因素，与未完成相关的需求和障碍。
方法：我们采用混合方法设计，同时对回顾性队列和定性研究进行三角测量。
方法：澳大利亚农村地区的经济劣势地区。
方法：患者（≥18岁）通过中央转诊系统进行心脏康复，生活在社会经济地位较低的农村地区。
方法：采用逆概率加权平衡的Cox生存模型来评估心脏康复利用与12个月死亡率/心血管再入院之间的关联。通过逻辑回归测试与未完成的关联。通过半结构化访谈和焦点小组的主题分析，调查了完成心脏康复的障碍和需求（n=28）。
结果：在16,159个合格的离职中，44.3%被转介，11.2%完成心脏康复。完成计划（HR0.65;95CI0.57-0.74;p<0.001）可降低心血管再入院/死亡的风险。独居(OR1.38；95CI1.00-1.89；p=0.048)，患有糖尿病（OR1.48；95CI1.02-2.13；p=0.037），或患有抑郁症(OR1.54；95CI1.14-2.08；p=0.005)，与未完成的风险较高相关,而参加远程医疗项目与未完成的风险较低相关(OR0.26;95CI0.18-0.38;p<0.001).与物流问题相关的主题，社会支持,护理挑战的转变，缺乏护理整合，以人为本成为完成工作的障碍。
结论：心脏康复完成度低，但可有效降低死亡率/心血管再入院。通过混合方法了解和解决障碍和需求可以帮助为弱势群体量身定制心脏康复计划，并改善完成情况和结果。
方法：我们采用混合方法设计，同时对回顾性队列和定性研究进行三角测量。
方法：澳大利亚农村地区的经济劣势地区。
方法：患者（≥18岁）通过中央转诊系统进行心脏康复，生活在社会经济地位较低的农村地区。
方法：采用逆概率加权平衡的Cox生存模型来评估心脏康复利用与12个月死亡率/心血管再入院之间的关联。通过逻辑回归测试与未完成的关联。通过半结构化访谈和焦点小组的主题分析，调查了完成心脏康复的障碍和需求（n=28）。
结果：在16,159个合格的离职中，44.3%被转介，11.2%完成心脏康复。完成计划（HR0.65;95CI0.57-0.74;p<0.001）可降低心血管再入院/死亡的风险。独居(OR1.38；95CI1.00-1.89；p=0.048)，患有糖尿病（OR1.48；95CI1.02-2.13；p=0.037），或患有抑郁症(OR1.54；95CI1.14-2.08；p=0.005)，与未完成的风险较高相关,而参加远程医疗项目与未完成的风险较低相关(OR0.26;95CI0.18-0.38;p<0.001).与物流问题相关的主题，社会支持,护理挑战的转变，缺乏护理整合，以人为本成为完成工作的障碍。
结论：心脏康复完成度低，但可有效降低死亡率/心血管再入院。通过混合方法了解和解决障碍和需求可以帮助为弱势群体量身定制心脏康复计划，并改善完成情况和结果。
