A computerized decision support system did not improve personalization of exercise-based cardiac rehabilitation according to latest recommendations

European Journal of Preventive Cardiology, vol. 28, pp. 572–580

Abstract

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.

Authors 5

1. Tom Vromen corresponding

   Maastricht University Medical Centre · Amsterdam UMC Location University of Amsterdam · Maastricht University · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Cardiology, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

   Department of Medical Informatics, Amsterdam UMC, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands

2. Niels B. Peek

   University of Manchester · Farr Institute

   Affiliation as printed

   Health e-Research Centre, Farr Institute of Health Informatics Research, University of Manchester, Vaughan HousePortsmouth Street, Manchester M13 9GB, UK

3. Ameen Abu–Hanna

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Medical Informatics, Amsterdam UMC, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands

4. Marion Kornaat Aachen Department of Cardiac Rehabilitation Rijnlands Rehabilitation Center

   Rijnlands Revalidatie Centrum

   Affiliation as printed

   Department of Cardiac Rehabilitation, Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333AL, Leiden, the Netherlands

5. Hareld Kemps

   Máxima Medisch Centrum

   Affiliation as printed

   Department of Cardiology, Maxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, the Netherlands