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Date of Award

12-16-2020

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

Thesis Committee Chairperson

Veronica Valazza, DNP, MBA, RN, NE-BC

Additional Advisor

Shirley Triplet MSN, NP

Abstract

Clinical Problem: The clinical problem discussed in this proposal is the underutilization of cardiac rehabilitation as a secondary prevention measure for cardiovascular disease, despite evidence supporting it a class 1 recommendation by the American College of Cardiology. Participation rates are very low, with national analysis revealing participation rates ranging from 19-34% (Ades et al., 2018). Experts agree that underutilization may in part be due to barriers in participation, and that novel delivery methods need to be explored as a means to increasing participation (Thomas et al., 2019).

Significance: The significance of this proposal is to improve secondary prevention, risk factor management, and mortality for patients with cardiovascular disease by creating a more accessible and flexible option for participating in cardiac rehabilitation. Increasing participation in cardiac rehabilitation can lead to decreased healthcare costs, hospital readmissions, and mortality and morbidity. It is estimated that if CR participation were improved to 70% that 25,000 deaths and 180,000 hospitalizations could be prevented every year (Thomas et al., 2018).

PICOT question: Will offering home-based cardiac rehab via telehealth technology improve cardiac rehabilitation participation rates in patients with coronary atherosclerosis that have had an MI, PTCI, or CABG with or without heart failure?

Clinical change: The proposed clinical practice change is to implement a home-based cardiac rehabilitation program in addition to the current delivery method of center-based cardiac rehabilitation in an effort to minimize common barriers to participation. The evidence suggests similar effectiveness in reducing morbidity, mortality, and re-hospitalization when compared to center based cardiac rehabilitation (Aamot et al., 2016; Bravo-Escobar et al., .2017; Chen et al., 2018; Dorje et al., 2019; Thomas et al., 2019; Murphy et al, 2020).

Desired outcomes: The desired outcomes are to increase cardiac rehabilitation participation by offering a home-based alternative, achieve improved risk factor management, decrease mortality and morbidity, and decrease the delay in starting cardiac rehab that may occur due to lack of program availability and waitlists.

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