Development of evidence-based clinical algorithms for prescription of exercise-based cardiac rehabilitation.
BACKGROUND
Guideline adherence with respect to exercise-based cardiac rehabilitation (CR) is hampered by a large variety of complex guidelines and position statements, and the fact that these documents are not specifically designed for healthcare professionals prescribing exercise-based CR programs. This study aimed to develop clinical algorithms that can be used in clinical practice for prescription and evaluation of exercise-based CR in patients with coronary artery disease (CAD) and chronic heart failure (CHF).


METHODS
The clinical algorithms were developed using a systematic approach containing four steps. First, all recent Dutch and European cardiac rehabilitation guidelines and position statements were reviewed and prioritised. Second, training goals requiring a differentiated training approach were selected. Third, documents were reviewed on variables to set training intensity, modalities, volume and intensity and evaluation instruments. Finally, the algorithms were constructed.


RESULTS
Three Dutch guidelines and three European position statements were reviewed. Based on these documents, five training goals were selected and subsequently five algorithms for CAD patients and five for CHF patients were developed.


CONCLUSIONS
This study presents evidence-based clinical algorithms for exercise-based CR in patients with CAD and CHF according to their training goals. These algorithms may serve to improve guideline adherence and the effectiveness of exercise-based CR.
Radboud Institute for Health Sciences, Radboud University Medical Center, IQ healthcare, Geert Grooteplein 21, 6500 HB, Nijmegen, The Netherlands. Retze.Achttien@gmail.com.
R J
RJ
Achttien
Department of Medical Informatics, University of Amsterdam, Amsterdam, The Netherlands.
T
T
Vromen
Radboud Institute for Health Sciences, Radboud University Medical Center, IQ healthcare, Geert Grooteplein 21, 6500 HB, Nijmegen, The Netherlands.|Institute Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
J B
JB
Staal
Department of Medical Informatics, University of Amsterdam, Amsterdam, The Netherlands.|Health e-Research Centre, University of Manchester, Manchester, UK.
N
N
Peek
Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands.
R F
RF
Spee
Department of Sports Medicine, Elkerliek Hospital, Helmond, The Netherlands.
V M
VM
Niemeijer
Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands.
H M
HM
Kemps
Cardiac rehabilitation; Chronic heart failure; Clinical algorithms; Coronary artery disease; Exercise-based; Prescription