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Table 2 Characteristics of included studies and quality assessment tools/scores

From: A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure

Study details Population Quality assessment
Author (year) Study design/methods of data collection Country/setting Sample size Study/report aim Healthcare professional/s Tool (score)
Achttien et al. (2015) [32] Guideline review
Document analysis (Dutch and European CR guidelines and position statements), systematic review and expert panel
CR centres in Netherlands offering exercise-based CR N/R To develop evidence-based clinical algorithms that can serve as best practice standards for prescription and evaluation of exercise-based CR in patients with coronary artery disease and chronic HF Multidisciplinary expert panel (cardiologists, physiotherapists, sports physicians, occupational physicians, rehabilitation physician, human movement scientist and health informatician) AACODS checklist
[33] (medium-to-high)
Dalal et al. (2012) [34] Cross-sectional survey
Two-stage, postal questionnaire-based national survey (the stage 1 questionnaire responses were 224 out of 277 and 17 out of 24 for stage 2)
CR programmes in England, Wales and Northern Ireland n = 224 at stage 1 and n = 17 at stage 2 To determine why so few patients with chronic HF in England, Wales and Northern Ireland take part in CR Service managers and other heartcare professionals responsible for the CR service/team Centre for Evidence-Based Management survey questionnaire study checklist [35]
Frolich et al. (2010) [36] Observational, non-comparative case study
Surveys, before and after patient performance measurements, semi-structured interviews and observations (with key informants, including the leadership of the hospital and healthcare centres, a leading representative for the GPs, the project leaders, health professionals in the hospital and in the healthcare centre, and GPs)
Quality improvement project set up in Denmark: Bispbjerg University Hospital, the City of Copenhagen and the GPs in Copenhagen n = 44 GPs answered the mailed questionnaire To describe the process and results of a project that led to the development of new management practices and improvement of existing ones to support integrated care between three healthcare organisations Two specialists (in geriatrics and internal medicine), specialist physiotherapist, nurse specialist, project leaders, hospital management, department leadership, leadership of the healthcare centre, representatives of the GPs, ‘a steering committee’ and four working groups National Heart, Lung, and Blood Institute Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group [37]
Golwala et al. (2015) [38] Observational, prospective Get With The Guidelines–heart failure (GWTG-HF) registry and quality improvement programme
Used the GWTG-HF database to determine the contemporary proportional use, temporal trends, and major factors associated with referral for CR at discharge among eligible patients with HF
Various institutions representing community hospitals and tertiary-care referral centres from all USA geographic regions n = 338 To assess proportional use, temporal trends, and factors associated with CR referral at discharge among patients admitted with decompensated HF Hospital staff ordinarily looking after HF patients National Heart, Lung, and Blood Institute Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group [37] (medium)
Nguyen et al. (2013) [39] Observational, retrospective cohort study
Database analysis (multivariate logistic regression to examine patient characteristics, in-hospital diagnosis, clinical events, investigations associated with CR referral)
Hospitals in Canada, Ontario n = 11 To assess CR referral rates during index hospitalization (report the frequency and temporal trends of CR referral rates in Ontario, describe the factors associated with CR referral and examine the use of evidence-based medical therapies and their relationship with CR referral before hospital discharge) Hospital staff from 11 Canadian sites reporting to the Global Registry of Acute Coronary Events (GRACE) database Critical Appraisal Skills Programme Cohort Study Checklist [40] (medium-to-high)
Palmer et al. (2020) [41] National online cross-sectional survey (365 registered programmes were contacted and 165 healthcare professionals completed the survey) Cardiac rehabilitation programmes in Australia taking place in community settings and accepting HF patients
Programmes were excluded if their rehabilitation programme was conducted within an inpatient hospital setting
n = 165 healthcare professionals completed the survey The primary aim of the study was to identify clinician perceived barriers to engagement in rehabilitation for people with HF Participants were clinicians such as registered nurses or physiotherapists working as the programme coordinators Centre for Evidence-Based Management survey questionnaire study checklist
Piepoli et al. (2019) [42] Survey questionnaire study
Sub-analysis of the web-based Exercise Training in HF (ExtraHF) survey
Cardiac centres from the European Society of Cardiology affiliated countries n = 172 To investigate the regional variations in the implementation and prioritisation of exercise training programmes; to identify specific/local barriers to implementation Cardiologists, nurses, psychologists, exercise physiologists/therapists, dieticians, physiotherapists Centre for Evidence-Based Management survey questionnaire study checklist [35]
  1. CR Cardiac rehabilitation, HF Heart failure, N/R Not reported