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Canadian Journal of Cardiology

Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

  • Gabriela Lima de Melo Ghisi
    Affiliations
    KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Susan Marzolini, R. Kin
    Affiliations
    KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Faculty of Health, York University, Toronto, Ontario, Canada
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  • Jennifer Price
    Affiliations
    Women’s College Hospital, Toronto, Ontario, Canada
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  • Theresa M. Beckie
    Affiliations
    College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA

    College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
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  • Taslima Mamataz
    Affiliations
    KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Faculty of Health, York University, Toronto, Ontario, Canada
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  • Aliya Naheed
    Affiliations
    Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
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  • Sherry L. Grace
    Correspondence
    Corresponding author: Dr Sherry L. Grace, Faculty of Health, York University – Bethune 368, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada. Tel.: +1-416-736-2100 ×22364.
    Affiliations
    KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Faculty of Health, York University, Toronto, Ontario, Canada

    Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Author Footnotes
    Endorsed by: Association of Clinical and Academic Physiotherapists of Nigeria (ACAPN), American Society for Preventive Cardiology (ASPC), Association Francophone de Cardiologie Préventive (AFCP), Australian Cardiovascular Health and Rehabilitation Association (ACRA), Austrian Association of Prevention and Rehabilitation, Brazilian Association of Cardiorespiratory Physiotherapy and Intensive Care Physiotherapy (ASSOBRAFIR), British Association for Cardiovascular Prevention and Rehabilitation (BACPR), Cardiopulmonary and Metabolic Rehabilitation Study Group of the Department of Ergometry and Rehabilitation (DERC) of the Brazilian Society of Cardiology and DERC Women Committee, Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR), Chilean Society of Kinesiology in Cardiology and Cardiovascular Surgery (SOCKICAR), Costa Rican Association of Cardiology, Georgian Association of Cardiovascular Prevention and Rehabilitation (GACPR), Iranian Heart Foundation, Korean Academy of Cardiopulmonary Rehabilitation Medicine, Mexican Society for Heart Care, National Institute for Prevention and Cardiovascular Health (NIPC; Ireland), Pakistan Society of Physical Medicine and Rehabilitation (PSPMR), Philippine Heart Association, Cardiac Rehabilitation and Exercise Physiology Section of the Polish Cardiac Society (PCS), Saudi Heart Association Group for Prevention and Rehabilitation (SGCPR), Singapore Heart Foundation, Spanish Society of Cardiopulmonary Rehabilitation (SORECAR), Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation (TACVPR), and World Hypertension League (WHL).
Published:August 30, 2022DOI:https://doi.org/10.1016/j.cjca.2022.06.021

      Abstract

      Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR’s audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.

      Résumé

      La réadaptation cardiaque centrée (RC) sur les femmes (phase II) vise une meilleure participation des femmes, et pourrait permettre une plus grande amélioration de leur qualité de vie que les programmes traditionnels. Ces premières lignes directrices de pratique clinique, élaborées par l’International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), comportent des directives sur la façon de mettre en place des programmes de réadaptation centrée sur les femmes. Le comité de rédaction était composé d’experts provenant de diverses régions géographiques, dont des professionnels de la santé de plusieurs disciplines, un décideur politique et des patients partenaires. Les lignes directrices ont été élaborées selon les principes AGREE II (Appraisal of Guidelines for Research and Evaluation II) et RIGHT (Reporting Items for practice Guidelines in HealThcare). Les premières recommandations, basées sur une méta-analyse, ont été soumises à un panel Delphi composé d’auteurs d’articles de synthèse et de programmes de RC centrée sur les femmes, ciblés lors de l’enquête menée par l’ICCPR (N = 76). Les membres du panel ont évalué chacune des recommandations sur une échelle de Likert à sept points (dans laquelle un score plus élevé correspondait à une perception plus positive), en fonction de leurs répercussions et de leur applicabilité. Une rencontre virtuelle a été tenue pour atteindre un consensus et 15 panélistes ont confirmé la force des recommandations passées en revue (selon l’approche GRADE [Grading of Recommendations Assessment, Development, and Evaluation]). La version préliminaire des recommandations a été soumise à une révision externe par des sociétés de RC de partout dans le monde et a été diffusée publiquement en vue d’obtenir des commentaires. Les 14 recommandations préliminaires portaient sur l’orientation (l’orientation systématique et les encouragements à participer), le contexte (le choix du modèle, le respect de la vie privée et le personnel) et la prestation du programme (la modalité des exercices, l’aspect psychosocial, la formation et le renforcement des capacités d’autoprise en charge). Dix-neuf (25,0 %) réponses ont été reçues lors d’un sondage. Sauf pour une recommandation, les votes étaient à ≥ 75 % en faveur de l’inclusion des recommandations; quatre recommandations ont obtenu un score inférieur à 5/7 pour ce qui est de l’applicabilité, et une seule recommandation a obtenu un tel score pour ce qui est des répercussions. En définitive, une recommandation a été retirée, une a été séparée en deux recommandations distinctes, et toutes ont fait l’objet d’une révision (deux recommandations ont été révisées considérablement); une recommandation a ensuite été ajoutée. Dans l’ensemble, le degré de certitude des données probantes pour les recommandations finales a été évalué comme étant faible à modéré, tandis que la force des recommandations a été évaluée comme étant généralement élevée. Ces recommandations et les outils qui y sont associés peuvent soutenir la mise en place de tous les programmes, afin d’offrir de façon réalisable des programmes de RC centrée sur les femmes.

      Graphical abstract

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