Figure 1
Schematic overview of proposed solutions to the five interlinked roadblocks.
Figure 2
Hub-and-spoke model for cardiovascular health programs.
Figure 3
Strategies for strengthening the cardiovascular health program workforce.
Figure 4
Multi-level implementation strategies for high quality cardiovascular health programs.
Table 1
Overview of potential strategies, actions and evaluation to implement the WHF Roadmap on Cardiac Rehabilitation (pathway to lifelong cardiovascular health) using the Expert Recommendations for Implementing Change (ERIC) framework (87).
| STRATEGY | MAPPING TO ERIC CLASSIFICATION | DISCRETE ACTIONS | EVALUATION METHODS |
|---|---|---|---|
| Patient-level | |||
| Cardiovascular health plans (could be termed ‘cardiovascular health passports’) | Develop and organise quality monitoring, use clinical data systems, promote patient-held records | Develop and implement tools, integrate into care pathways, provide patient education and tools | Audit and feedback, quality improvement cycles, attendance, clinical outcomes, satisfaction |
| Patient education and engagement strategies | Conduct educational meetings, distribute educational materials, involve patients and family members | Deliver tailored education materials, peer support programs, community outreach | Pre–post evaluation Patient-reported outcomes |
| Access to person-centred and flexible models of care | Change service sites, revise professional roles, promote adaptability | Offer different models of care and modes of delivery with suitable workforce capability and resources | Reach and completion of programs, diversity of attendance, patient satisfaction |
| Clinician- and program-level | |||
| Workforce certification and training programs | Conduct educational meetings, develop educational materials, create a learning collaborative | Training and skills development, certification pathways, continuing education programs | Workforce competency metrics, uptake rates, clinician awareness |
| Integration into clinical pathways | Change record systems, revise professional roles, promote integration of services | Embed programs into primary and hospital care planning and chronic disease management | Cluster and stepped-wedge trials with evaluation of process, cost and patient-reported measures |
| Automated referral systems | Change record systems, facilitate relay of clinical data to providers, use clinical decision support | Implement electronic or paper-based referral triggers, training for staff | Audit and feedback, referral/enrolment/completion rates, eligible patient access |
| System-level | |||
| Universal access to lifelong cardiovascular health | Use policy levers, develop stakeholder interrelationships, promote adaptability, alter incentive structures | Policy integration, national rollout, standardisation | Policy evaluation with population-level indicators and unified data systems |
| Global benchmarking and registries | Audit and feedback, develop and organise quality monitoring systems, use data experts | Establish registries, standardise indicators based on evidence, enable cross-country comparisons | Observational analyses, multinational studies, case studies, wide dissemination |
| Mass media and awareness campaigns | Use mass media, conduct local consensus discussions, involve patients/consumers | Public campaigns, targeted messaging | Population awareness metrics, attendance and completion rates, health outcomes, value |