Multicenter Study

. 2020 Feb 12;10(2):e031995.

doi: 10.1136/bmjopen-2019-031995.

Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARD^PCI)

Tone M Norekvål^{1

2

3}, Heather G Allore^{4

5}, Bjørn Bendz^{6

7}, Cathrine Bjorvatn^{2

8}, Britt Borregaard⁹, Gunhild Brørs¹⁰, Christi Deaton¹¹, Nina Fålun^{12

3}, Heather Hadjistavropoulos¹³, Tina Birgitte Hansen^{14

15}, Stig Igland¹⁶, Alf Inge Larsen^{2

17}, Pernille Palm¹⁸, Trond Røed Pettersen^{12

2}, Trine Bernholdt Rasmussen¹⁹, Jan Schjøtt^{2

20}, Rikke Søgaard^{21

22}, Irene Valaker²³, Ann Dorthe Zwisler²⁴, Svein Rotevatn¹²; CONCARD Investigators

Affiliations

¹ Department of Heart Disease, Haukeland University Hospital, Bergen, Norway tone.merete.norekval@helse-bergen.no.
² Department of Clinical Science, University of Bergen, Bergen, Norway.
³ Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
⁴ Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁵ Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA.
⁶ Department of Cardiology, Oslo University Hospital, Oslo, Norway.
⁷ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁸ Centre on Learning and Mastery, Haukeland University Hospital, Bergen, Norway.
⁹ Department of Cardiology, Odense University Hospital, Odense, Denmark.
¹⁰ Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
¹¹ Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
¹² Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
¹³ Department of Psychology, University of Regina, Regina, Saskatchewan, Canada.
¹⁴ Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark.
¹⁵ Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹⁶ Medical Clinic, Førde Hospital Trust, Førde, Norway.
¹⁷ Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
¹⁸ Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
¹⁹ Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
²⁰ Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
²¹ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
²² Department of Public Health, Aarhus University, Aarhus, Denmark.
²³ Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.
²⁴ The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.

PMID: 32054625
PMCID: PMC7045256
DOI: 10.1136/bmjopen-2019-031995

Multicenter Study

Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARD^PCI)

Tone M Norekvål et al. BMJ Open. 2020.

. 2020 Feb 12;10(2):e031995.

doi: 10.1136/bmjopen-2019-031995.

Authors

Affiliations

¹ Department of Heart Disease, Haukeland University Hospital, Bergen, Norway tone.merete.norekval@helse-bergen.no.
² Department of Clinical Science, University of Bergen, Bergen, Norway.
³ Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
⁴ Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁵ Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA.
⁶ Department of Cardiology, Oslo University Hospital, Oslo, Norway.
⁷ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁸ Centre on Learning and Mastery, Haukeland University Hospital, Bergen, Norway.
⁹ Department of Cardiology, Odense University Hospital, Odense, Denmark.
¹⁰ Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
¹¹ Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
¹² Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
¹³ Department of Psychology, University of Regina, Regina, Saskatchewan, Canada.
¹⁴ Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark.
¹⁵ Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹⁶ Medical Clinic, Førde Hospital Trust, Førde, Norway.
¹⁷ Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
¹⁸ Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
¹⁹ Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
²⁰ Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
²¹ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
²² Department of Public Health, Aarhus University, Aarhus, Denmark.
²³ Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.
²⁴ The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.

PMID: 32054625
PMCID: PMC7045256
DOI: 10.1136/bmjopen-2019-031995

Abstract

Introduction: Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust their lifestyle, incorporate medications and acquire new support. Thus, CONCARD^PCI will identify bottlenecks in the patient journey from a patient perspective to lay the groundwork for integrated, coherent pathways with innovative modes of healthcare delivery. The main objective of the CONCARD^PCI is to investigate (1) continuity of care, (2) health literacy and self-management, (3) adherence to treatment, and (4) healthcare utilisation and costs, and to determine associations with future short and long-term health outcomes in patients after PCI.

Methods and analysis: This prospective multicentre cohort study organised in four thematic projects plans to include 3000 patients. All patients undergoing PCI at seven large PCI centres based in two Nordic countries are prospectively screened for eligibility and included in a cohort with a 1-year follow-up period including data collection of patient-reported outcomes (PRO) and a further 10-year follow-up for adverse events. In addition to PROs, data are collected from patient medical records and national compulsory registries.

Ethics and dissemination: Approval has been granted by the Norwegian Regional Committee for Ethics in Medical Research in Western Norway (REK 2015/57), and the Data Protection Agency in the Zealand region (REG-145-2017). Findings will be disseminated widely through peer-reviewed publications and to patients through patient organisations.

Trial registration number: NCT03810612.

Keywords: adherence to treatment; continuity of care; health literacy; healthcare utilisation; percutaneous coronary intervention; rehabilitation.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Projects in CONCARD^PCI researching bottlenecks for good and efficient patient pathways across levels of healthcare.

**Figure 2**
Measuring time points and data collection in the cohort study in CONCARD^PCI.

**Figure 3**
H=PCI centres including the local hospitals in their catchment area.

See this image and copyright information in PMC

References

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1. Magnani JW, Mujahid MS, Aronow HD, et al. . Health literacy and cardiovascular disease: fundamental relevance to primary and secondary prevention: a scientific statement from the American heart association. Circulation 2018;138:e48–74. 10.1161/CIR.0000000000000579 - DOI - PMC - PubMed
1. Piepoli MF, Corrà U, Dendale P, et al. . Challenges in secondary prevention after acute myocardial infarction: a call for action. Eur J Cardiovasc Nurs 2017;16:369–80. 10.1177/1474515117702594 - DOI - PubMed
1. Timmis A, Townsend N, Gale C, et al. . European Society of cardiology: cardiovascular disease statistics 2017. Eur Heart J 2018;39:508–79. 10.1093/eurheartj/ehx628 - DOI - PubMed
1. Haggerty JL, Freeman GK, Starfield BH. Continuity of care: a multidisciplinary review. BMJ 2003;327:1219–21. 10.1136/bmj.327.7425.1219 - DOI - PMC - PubMed

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Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARD^PCI)

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Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARD^PCI)

Authors

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Conflict of interest statement

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