TY - JOUR
T1 - A computerized decision support system did not improve personalization of exercise-based cardiac rehabilitation according to latest recommendations
AU - Vromen, Tom
AU - Peek, Niels B.
AU - Abu-Hanna, Ameen
AU - Kornaat, Marion
AU - Kemps, Hareld M.
N1 - Funding Information: This project was funded by SAG (Stichting Achmea Gezondheidszorg), under the project name: Beslissingsondersteuning voor fysieke training in het kader van hartrevalidatie. The researchers were independent from the funder. SAG had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. N.B.P. was partially funded by the Engineering and Physical Sciences Research Council (EP/P010148/1) and by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, theNIHR or the Department of Health. Publisher Copyright: © 2020 The Author(s).
PY - 2021/5/1
Y1 - 2021/5/1
N2 - AIMS: Recent studies showed that exercise-based cardiac rehabilitation (ECR) programmes are often not personalized to individual patient characteristics according to latest recommendations. This study investigates whether a computerized decision support (CDS) system based on latest recommendations and guidelines can improve personalization of ECR prescriptions. Pseudo-randomized intervention study. METHODS AND RESULTS: Among participating Dutch cardiac rehabilitation centres, ECR programme characteristics of consecutive patients were recorded during 1 year. CDS was used during a randomly assigned 4-month period within this year. Primary outcome was concordance to latest recommendations in three phases (before, during, and after CDS) for 12 ECR programme characteristics. Secondary outcome was variation in training characteristics. We recruited ten Dutch CR centres and enrolled 2258 patients to the study. Overall concordance of ECR prescriptions was 59.9% in Phase 1, 62.1% in Phase 2 (P = 0.82), and 59.9% in Phase 3 (P = 0.56). Concordance varied from 0.0% to 99.9% for the 12 ECR characteristics. There was significant between-centre variation for most training characteristics in Phases 1 and 2. In Phase 3, there was only a significant variation for aerobic and resistance training intensity (P = 0.01), aerobic training volume (P < 0.01), and the number of strengthening exercises but no longer for the other characteristics. Aerobic training volume was often below recommended (28.2%) and declined during the study. CONCLUSION: CDS did not substantially improve concordance with ECR prescriptions. As aerobic training volume was often lower than recommended and reduced during the study, a lack of institutional resources might be an important barrier in personalizing ECR prescriptions.
AB - AIMS: Recent studies showed that exercise-based cardiac rehabilitation (ECR) programmes are often not personalized to individual patient characteristics according to latest recommendations. This study investigates whether a computerized decision support (CDS) system based on latest recommendations and guidelines can improve personalization of ECR prescriptions. Pseudo-randomized intervention study. METHODS AND RESULTS: Among participating Dutch cardiac rehabilitation centres, ECR programme characteristics of consecutive patients were recorded during 1 year. CDS was used during a randomly assigned 4-month period within this year. Primary outcome was concordance to latest recommendations in three phases (before, during, and after CDS) for 12 ECR programme characteristics. Secondary outcome was variation in training characteristics. We recruited ten Dutch CR centres and enrolled 2258 patients to the study. Overall concordance of ECR prescriptions was 59.9% in Phase 1, 62.1% in Phase 2 (P = 0.82), and 59.9% in Phase 3 (P = 0.56). Concordance varied from 0.0% to 99.9% for the 12 ECR characteristics. There was significant between-centre variation for most training characteristics in Phases 1 and 2. In Phase 3, there was only a significant variation for aerobic and resistance training intensity (P = 0.01), aerobic training volume (P < 0.01), and the number of strengthening exercises but no longer for the other characteristics. Aerobic training volume was often below recommended (28.2%) and declined during the study. CONCLUSION: CDS did not substantially improve concordance with ECR prescriptions. As aerobic training volume was often lower than recommended and reduced during the study, a lack of institutional resources might be an important barrier in personalizing ECR prescriptions.
KW - Cardiac rehabilitation
KW - Computerized decision support
KW - Exercise training
KW - Personalized medicine
UR - http://www.scopus.com/inward/record.url?scp=85107082328&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/eurjpc/zwaa066
DO - https://doi.org/10.1093/eurjpc/zwaa066
M3 - Article
C2 - 33624044
SN - 2047-4873
VL - 28
SP - 572
EP - 580
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 5
ER -