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Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment

Cossette, Sylvie; Frasure-Smith, Nancy; Dupuis, Jocelyn; Juneau, Martin; Guertin, Marie-Claude

doi: 10.1097/NNR.0b013e318240dc6b

Background: Short hospital stays for patients with acute coronary syndromes (ACSs) reduce the opportunity for risk factor intervention during admission. After discharge, cardiac rehabilitation can decrease the recurrence of coronary events by up to 25%. However, it remains underused.

Objectives: The aim of this study was to determine whether a nursing intervention focused on individual ACS patients’ perceptions of their disease and treatment would increase rehabilitation enrollment after discharge.

Method: A total of 242 ACS patients admitted to a specialized tertiary cardiac center were randomized to either the intervention or usual care (n = 121 in both groups). The intervention included one nurse–patient meeting before discharge with 2 additional contacts over the 10 days after discharge (mean duration = 40 minutes per contact). The primary outcome was enrollment in a free rehabilitation program offered to all participants 6 weeks after discharge. Secondary outcomes included illness perceptions; family support; anxiety level; medication adherence; and cardiac risk factors including lack of exercise, smoking, body mass index, and diet.

Results: The sample was composed of a majority of male, married workers who experienced a myocardial infarction or unstable angina without severe complications. The mean hospital stay in both groups was 3.6 days. There was a significantly higher rate of rehabilitation enrollment in the intervention group (45%) than in the control group (24%; p = .001). For the secondary outcomes, only the personal control dimension of illness perceptions was improved significantly with the intervention.

Discussion: Progressive, individualized interventions by nurses resulted in greater rehabilitation enrollment, thereby potentially improving long-term outcome.

Sylvie Cossette, PhD, RN, is Professor, University of Montreal, and Researcher, Montreal Heart Institute Research Center, Quebec, Canada.

Nancy Frasure-Smith, PhD, is Professor, McGill University, and Researcher, Centre Hospitalier de l’Université de Montréal and Montreal Heart Institute Research Center, Quebec, Canada.

Jocelyn Dupuis, MD, PhD, is Cardiologist, Montreal Heart Institute, and Associate Professor of Medicine, University of Montreal, Quebec, Canada.

Martin Juneau, MD, FRCP, is Cardiologist and Director of Prevention, Montreal Heart Institute Research Center, Quebec, Canada.

Marie-Claude Guertin, PhD, is Chief Statistician, Montreal Heart Institute Coordinating Center, Quebec, Canada.

Accepted for publication October 11, 2011.

We thank the patients who generously agreed to participate. We thank the nurses, including Johane Loyer, RN, BSc, Magali Morin, RN, BSc, Sylvie Lamadeleine, RN, BSc, and Margaret Purden, RN, PhD, as well as the directors of nursing who supported the project (Suzanne Daigle, RN, MSc, and Marie-Hélène Carbonneau, RN, MSc).

Funding was obtained by the Fonds de la recherche en santé du Québec (FRSQ), the Quebec Interuniversity Nursing Intervention Research Group (GRIISIQ), and the Montreal Heart Institute Foundation and Research Center. Writing and editing consultation were provided by Kate Johnson, BA (Joint Hons), BJ (Hons).

The authors have no conflicts of interest to disclose.

Corresponding author: Sylvie Cossette, PhD, RN, Montreal Heart Institute Research Center, R-223, 5000, Bélanger est, Quebec, Canada H1T 1C8 (e-mail:

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