This work consisted of a survey of current provision of cardiac rehabilitation, a qualitative synthesis of the experiences, attitudes, beliefs and expectations of self-management of heart failure and a systematic review and meta-analysis of cardiac rehabilitation (CR) in people with HFpEF.
Full data were available for 84% (232/277) CR centres across England, Wales and Northern Ireland. Only 40% routinely offered CR to patients with HF. Only 16% (35/224) of respondents provide a dedicated CR service for patients with HF. Lack of resources and commissioning are seen as major barriers to offering CR in this group.
Dalal H M, Wingham J, Palmer J, Taylor R, Petre C, Lewin R. Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland. BMJ Open, 2012, 2(2). Read the full survey here.
Systematic reviews and meta-analyses
The following systematic reviews have been published by the research team:
Taylor R, Davies EJ, Dalal HM, Davis R, Doherty P, Cooper C, Holland DJ, Jolly K, Smart NA. Effects of exercise training for heart failure with preserved ejection fraction: A systematic review and meta-analysis of comparative studies. International Journal of Cardiology, 2012,162(1):6-13.
Read the full review here.
Brown JP, Clark AM, Dalal H, Welch K, Taylor RS. Effect of patient education in the management of coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.European Journal of Preventive Cardiology, 2013 Aug, 20(4):701-14. Read the full review here.
Anderson L & Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews, 2014 Dec, 12:CD011273. Read the full review here.
Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F, Rees K, Singh S, Taylor RS. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart, 2015 Jan, 2(1):e000163. Read the full review here.
Taylor RS, Dalal H, Jolly K, Zawada A, Dean SG, Cowie A, Norton RJ. Home-based versus centre-based cardiac rehabilitation.Cochrane Database of Systematic Reviews, 2015 Aug, 8:CD007130. Read the full review here.
Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis.Journal of the American College of Cardiology, 2016 Jan, 67(1):1-12. Read the full review here.
Nineteen qualitative studies were identified. Our resultant five phase conceptual model starts with patients’ initial experiences of disruption across physical, emotional, social and psychological domains. Patients then pass through four more phases beginning with a sense making phase influenced by knowledge, their engagement with health professionals and their personal attributes.
The next phase is ‘reaction’ during which patients adopt one of four reactions: strategic avoider; selective denier; well-intentioned self-manager; advanced self-manager. The next phase of response is partially dependent on social factors including support from caregivers. Finally, patients seek to assimilate their management into daily life.
Wingham, J, Harding, G, Britten, N, Dalal, H. Heart failure patients’ attitudes, beliefs, expectations and experiences of self-management strategies: A qualitative synthesis. Chronic Illness, 2014 Jun, 10(2):135-54. Read the full qualitative review here.
As a prelude to the development of the HF Manual, we have engaged with individuals with HF (through focus groups and questionnaires) and key healthcare staff to explore the needs of HF and treatment goals.