P30 Rapid overviews for pragmatic transfer of knowledge from research to practice

Abstract

Background Today, many more people are surviving sudden cardiovascular events and living longer with cardiovascular disease, thanks to advances in preventive strategies and advanced treatment. Hence, rehabilitation and palliative care interventions have become an important focus for improving the lives of patients living with cardiovascular diseases. Drawing on ‘review of reviews’ and rapid review methodology, as well as evidence gap maps, we worked with non-academic stakeholders at the Danish Heart Foundation (DHF) to co-produce a contemporary overview to uniquely bring together the evidence for the efficacy of rehabilitation and palliative care across a wide spectrum of cardiovascular diseases. The overview summarises the current evidence but also identifies where gaps in the evidence exist. Methods End user feedback was sought on the protocol and at key points in the overview process. Six bibliographic databases were searched for systematic reviews. Only articles published after 2009 were included. Quality of SRs was assessed using the R-AMSTAR tool. A narrative synthesis was performed and a summary of the most recent systematic review(s)/meta-analyses for efficacy of rehabilitation for each of the included CVD conditions presented using accessible graphic visualisations of data (infographics). Results The overview finds that the evidence for rehabilitation in coronary heart disease and heart failure is well established as well as supervised exercise training in intermittent claudication. Improved access to rehabilitation is needed for these indications. There is a dearth of studies on the efficacy of dietary and smoking interventions in CVD indications. Also, further research is needed on palliative care interventions for heart failure and other life-threatening cardiovascular diseases. Conclusion A pragmatic, flexible approach to conducting this overview, together with meaningful involvement of end users, facilitated completion of a comprehensive overview to deadline (six months), identified gaps in the evidence, improved accessibility of findings and ensured relevance to real world settings. Limitations included no attempt to search for individual randomised controlled trials (RCTs), to perform updates or undertake de novo SRs. We only focused on the effectiveness of rehabilitation and palliative interventions for CVD relative to control and did not consider the relative effectiveness of different components of interventions (for example, type, duration, frequency of exercise training) or settings. The overview highlights the need to prioritise high quality studies that establish the effectiveness of rehabilitation in cardiovascular indications where there is currently little or no evidence.