An Integrative Review of Formal Functional Support in Cardiac Rehabilitation Among Patients With Coronary Artery Disease After Revascularization

BACKGROUND: Ischemic heart disease is a major cause of premature death and disability worldwide. The chances for a recurrent coronary event and mortality increase significantly after the first event. Cardiac rehabilitation (CR) is an effective secondary prevention measure in reducing morbidity and mortality after a coronary event. Despite these benefits, fewer than 30% of eligible patients with coronary artery disease complete the recommended number of CR sessions. OBJECTIVE: In this integrative review, our aim was to synthesize research on the relationship between formal functional social support and CR participation and completion among adults with coronary artery disease. METHODS: We searched PubMed, Scopus, and CINAHL databases from inception to June 2023. Quantitative, qualitative, and mixed-methods studies were included. Two independent reviewers screened titles, abstracts, and full-text reviews. The study quality was appraised using the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool. RESULTS: An initial search yielded 629 studies; 9 were included, and 1 was added after a hand search. Of the 10 studies reviewed, 6 were quantitative (60%), whereas 20% were qualitative and 20% were mixed-methods studies. Two main types of formal support interventions emerged: (1) individual interventions delivered one-on-one; and (2) system-level interventions, which involved modifying the environment to better support participants. There were 7 studies in which support interventions were targeted at the individual level, while 3 were focused at the environmental/systemic level. Participants who received support interventions had increased enrollment and participation in CR programs. CONCLUSIONS: Formal functional support was not objectively measured in the studies reviewed. However, participants expressed satisfaction with formal functional support programs, valued guidance from healthcare professionals, and the flexibility offered by support programs.