Original ArticlePsychosocial Screening and Assessment Practice within Cardiac Rehabilitation: A Survey of Cardiac Rehabilitation Coordinators in Australia
Introduction
Coronary Heart Disease (CHD) is the leading cause of death in Australia [1]. Patients who have had a cardiac event are at increased risk of a subsequent event and death [2] and are, therefore, a priority for preventive cardiology [3]. As such, in Australia [4] and worldwide [5], it is recommended that cardiac rehabilitation (CR) be offered to all patients after an acute event. Cardiac rehabilitation is a multidisciplinary intervention, which improves functional capacity, recovery and psychological well-being [5], [6], [7]. Cardiac rehabilitation has been shown to reduce the risk of further heart attack or death by 25-30% [8], [9]. In addition, models of care that incorporate psychosocial and education-based CR [10], [11] may improve the health-related quality of life [12]. As the European Association of Cardiovascular Prevention and Rehabilitation notes [13] CR is recommended (with the highest level of scientific evidence-class I) by the European Society of Cardiology, the American Heart Association and the American College of Cardiology in the treatment of patients with coronary artery disease (CAD) [14], [15], [16].
Centre-based group programs are the major systematic approach to CR currently available in Australia. Group CR typically comprises low or moderate intensity physical activity; and education and discussion, with programs usually running for six to eight weeks [4], [6]. Cardiac rehabilitation aims to restore individuals to their optimal level of physical, psychological, social and vocational wellbeing and is considered ‘an essential part of the contemporary care of heart disease’ [17].
Section snippets
Current Guidelines for Psychosocial Screening in CR
According to the recently published core components of cardiac disease secondary prevention and rehabilitation [18], [19] it is recommended that patients be formally assessed at entry to the program and a mutually agreed treatment plan devised, and assessed again at exit and at 6- and 12-month follow-up. It is recommended that the entry assessment include medical history; current medications; physical and functional status; risk factor profiles; health behaviours including, for example,
Participants
Eligible participants were coordinators of CR programs currently operating in Australia. Based on a 5% margin of error and 95% confidence intervals, a sample of 174 CR coordinators was required [40]. This represented a 50% response rate (of the full population of 314 CR programs).
Measures
An online survey was developed which asked about screening activities across a range of traditional and emerging CVD risk factors and included an assessment of who undertakes the screening, how it is done, and the
Screening
Of the 314 CR programs invited to participate, 180 responses were received. Of these, four declined to complete the survey after reading the plain language statement, leaving 176, the required target sample size. Just over 50% (52.5%) of program coordinators were included although 11 surveys were incomplete, resulting in 165 complete responses (49%). Of these complete responses 157 (95%) respondents indicated that they screened at entry while 132 (80%) indicated that they screened on exit.
Discussion
Most programs undertake some form of psychosocial screening or assessment of patients at program entry (95%) and exit (82%), with depression being the psychosocial factor screened for most commonly. The take-up rate of screening for depression, of over 80%, is higher than the rates identified in a recent survey of depression screening in North America [73] where the highest screening rate identified was under 70%. Depression screening using the validated screening tool recommended for
Conclusion
Surveys such as this national survey of screening and assessment practice in CR are useful for monitoring the use of guideline recommendations and identification of barriers to implementation, particularly of recommendations on screening. The findings from this study should also contribute to discussions about what to include in a minimum data set for CR programs, and the identification of brief screening tools that have been validated not just in the general population but in cardiac patients,
Conflict of Interest
None declared.
Acknowledgement
We thank the Australian Cardiovascular Health and Rehabilitation Association (ACRA) for their endorsement in this project.
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