A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities

Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and particip...

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Vydané v:	Circulation (New York, N.Y.) Ročník 147; číslo 3; s. 254
Hlavní autori:	Beatty, Alexis L, Beckie, Theresa M, Dodson, John, Goldstein, Carly M, Hughes, Joel W, Kraus, William E, Martin, Seth S, Olson, Thomas P, Pack, Quinn R, Stolp, Haley, Thomas, Randal J, Wu, Wen-Chih, Franklin, Barry A
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 17.01.2023
Predmet:	Cardiac Rehabilitation - methods Cardiovascular Diseases - therapy Caregivers Evidence Gaps Humans coronary disease heart failure telemedicine cardiac rehabilitation
ISSN:	1524-4539, 1524-4539
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Abstract	Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
AbstractList	Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD. Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
Author	Pack, Quinn R Beckie, Theresa M Olson, Thomas P Stolp, Haley Franklin, Barry A Goldstein, Carly M Martin, Seth S Dodson, John Beatty, Alexis L Kraus, William E Hughes, Joel W Thomas, Randal J Wu, Wen-Chih
Author_xml	– sequence: 1 givenname: Alexis L orcidid: 0000-0001-8405-7386 surname: Beatty fullname: Beatty, Alexis L organization: Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco – sequence: 2 givenname: Theresa M orcidid: 0000-0001-8985-2725 surname: Beckie fullname: Beckie, Theresa M organization: College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa – sequence: 3 givenname: John surname: Dodson fullname: Dodson, John organization: Department of Population Health (J.D.), New York University School of Medicine, New York – sequence: 4 givenname: Carly M orcidid: 0000-0002-6150-5649 surname: Goldstein fullname: Goldstein, Carly M organization: Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI – sequence: 5 givenname: Joel W surname: Hughes fullname: Hughes, Joel W organization: Department of Psychological Sciences, Kent State University, OH (J.W.H.) – sequence: 6 givenname: William E orcidid: 0000-0003-1930-9684 surname: Kraus fullname: Kraus, William E organization: Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.) – sequence: 7 givenname: Seth S orcidid: 0000-0002-7021-7622 surname: Martin fullname: Martin, Seth S organization: Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.) – sequence: 8 givenname: Thomas P surname: Olson fullname: Olson, Thomas P organization: Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.) – sequence: 9 givenname: Quinn R surname: Pack fullname: Pack, Quinn R organization: Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.) – sequence: 10 givenname: Haley orcidid: 0000-0003-1635-894X surname: Stolp fullname: Stolp, Haley organization: Centers for Disease Control and Prevention, Atlanta, GA (H.S.) – sequence: 11 givenname: Randal J surname: Thomas fullname: Thomas, Randal J organization: Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.) – sequence: 12 givenname: Wen-Chih orcidid: 0000-0002-2834-2024 surname: Wu fullname: Wu, Wen-Chih organization: Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.) – sequence: 13 givenname: Barry A surname: Franklin fullname: Franklin, Barry A organization: Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
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Title	A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities
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