PICO(T) Questions and an Evidence-Based Approach
PICOT Question and Search Strategy Template
- Define your question using PICOT (review the “Create PICOT Questions” page as needed):
Population: Patients who have experienced an acute myocardial infarction (AMI)
Intervention: Implementing an evidence-based cardiac rehabilitation program.
Comparison: Compared to standard post-AMI care without cardiac rehabilitation
Outcome: Reducing the risk of future cardiovascular events and mortality
Time (optional): Over one year
- Write out your question:
For a patient who has had AMI, what is the effect of implementing an evidence-based cardiac rehabilitation program instead of standard care immediately after an AMI on the risk of future cardiovascular events and mortality over a year? PICO(T) Questions and an Evidence-Based Approach
- Write down the most important words from your question in the gray boxes. For each top term, add synonyms or related terms in the boxes below it. All these are your search terms.
PLACE YOUR ORDER HERE NOW
| Acute myocardial infarction | AMI | heart attack | cardiac rehabilitation |
| recurrent events | cardiovascular risk | secondary prevention | exercise rehabilitation |
| mortality |
- Review the “Best Bets” in the Nursing Databases list. Check the databases you will search:
- Nursing & Allied Health
- Public Health Database
- PubMed Central
- Write in your first search below. Follow the instructions on the “Find EBP Articles…” page.
|
|||||||||
|
|||||||||
|
|||||||||
|
|
|
|
|
- Scholarly/peer-reviewed Limit publication date: 2020-2023
- Type of studies you want to include in your search:
- Systematic Review or Meta-Analysis
- Clinical Practice Guidelines
- Individual Research Studies
- What information did you find to help answer your question?
Two highly relevant sources were identified that provide good evidence to help answer this PICO(T) question:
Source 1:
Dibben, G., Faulkner, J., Oldridge, N., Rees, K., Thompson, D. R., Zwisler, A.-D., & Taylor, R. S. (2021). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, 2021(11). PICO(T) Questions and an Evidence-Based Approach https://doi.org/10.1002/14651858.cd001800.pub4
The present Cochrane systematic review was upgraded and included 85 randomized controlled trials with 23,430 participants with coronary heart disease, mostly having a myocardial infarction or revascularization procedure. The trials were designed to examine the effectiveness of exercise-based cardiac rehabilitation programs, including some that had psychosocial or educational components as further additions, against control groups that received no exercise intervention (Dibben et al., 2021). At the 6-12 months short-term follow-up, exercise-based cardiac rehab is most likely associated with a significant reduction of all-cause mortality, a large decrease in MI risk, and a need for hospitalization in individuals compared to the controls. The same results were probably observed regarding cardiovascular mortality, the need for CABG and PCI revascularization procedures, or cardiovascular hospitalizations.
At longer-term follow-ups, which reach three years, benefits may include a significant reduction in mortality caused by cardiovascular diseases and MI risk. Still, the evidence for the effect of revascularization needs to be more specific (Dibben et al., 2021). Cardiac rehab that centers on exercise was likewise noted to improve health-related quality of life measures, with effects that lasted up to a year. Furthermore, this intervention may be cost-effective. PICO(T) Questions and an Evidence-Based Approach
The review is reinforced by the evidence that exercise-based cardiac rehabilitation is essential in decreasing major adverse cardiovascular events and healthcare use for patients with coronary heart disease, especially during the first year but over a more extended follow-up period (Dibben et al., 2021). For a more accurate picture of the effectiveness, the trials need to be of a higher standard, and the patients should be representative of real-world practice.
Source 2:
Bruneau, J. E. E. (2020, May 1). The development and evaluation of the cardiovascular assessment screening program. Research.library.mun.ca. https://research.library.mun.ca/14388/
This exploratory mixed methods study of the CASP intervention for improving usage of CVD screening guidelines employed a Cardiovascular Assessment Screening Program (CASP) intervention. In the context of our research, the Knowledge-to-Action Framework came to be used as a guiding instrument. In the qualitative phase, interviews and focus group discussions with healthcare providers, managers, and the public were conducted to identify barriers, facilitators, and strategies for CVD screening, which provided the information needed for CASP’s planning (Bruneau, 2020). The Theoretical Domains Framework (TDF) was used to translate the findings for each intervention component. PICO(T) Questions and an Evidence-Based Approach
In the quantitative phase, a randomized controlled trial (RCT) was conducted involving four nurse practitioners and 167 patients aged 40-74 with no clinical history of CVD. The intervention group provided CASP during the specified time, while the other group offered the usual care. Statistical and clinical significance was shown through the analysis, which favored the intervention group in the comprehensiveness of screening (RR=43.9, p<0.0001) (Bruneau, 2020). The identification of various risk factors, the determination of CVD risk levels, the priority action planning with patients, and the personalized goal setting for heart health can be achieved by Intervention nurse practitioners.
Combining the qualitative and quantitative pieces helped confirm and refine strategies for knowledge translation of CVD screening guidelines in practice (Chapman, 2021). Through a strategic approach, CASP successfully deployed the guidelines to assess risks and offer risk reduction strategies by both providers and patients (Bruneau, 2020). This research approach allows for the development of a model that can be used to implement dance-based CVD prevention in clinical practice.
These two sources deliver a high-level systematic review and implementation report, demonstrating the use of complete, evidence-based cardiac rehabilitation programs for AMI patients to reduce mortality, morbidity, and future cardiac events over usual care. Specific mechanisms to guarantee all qualified AMI patients finish cardiac rehab programs are recommended due to this evidence (Ambrosetti et al., 2020). Other research can explore longer-term outcomes, cost-effectiveness, and specific program components. Still, this evidence indicates that cardiac rehab should be standard AMI treatment to achieve better recovery and prevention of recurrent events. PICO(T) Questions and an Evidence-Based Approach
Other relevant Findings
New research demonstrates that cardiac rehabilitation (CR) programs, especially those targeting the reduction of cardiovascular death and rehospitalization, directly contribute to the improvement in patient’s quality of life and functional capacity after an acute myocardial infarction (AMI). The primary result shows the positive effect of early cardiac rehabilitation that begins in the acute phase after AMI and leads to improved cardiac function, particularly in left ventricular remodeling and ejection fraction. Furthermore, it enhances the patient’s physical and mental condition by increasing exercise capacity and diminishing the symptoms of depression (Darvishzadehdaledari et al., 2023; Schon et al., 2024). Moreover, the effectiveness of comprehensive cardiac rehabilitation programs, including exercise training, risk factor management, and psychosocial touching on patient outcomes, has also been found to be very substantial. However, although there are many advantages to those programs, the low number of program enrollment and completion is noticeable due to discrimination by race and socio-economic factors. Innovative modalities, such as home-based and hybrid cardiac rehabilitation, have been discovered to be as effective as physical in-person institutions, and their effect came to light during the COVID-19 pandemic as physical distancing was required (Basognano, 2023).
Relevance of the Other Findings
The results of the studies are highly relevant to clinicians’ and policymakers’ decision-making. They underscore the importance of incorporating cardiac rehabilitation into routine care for AMI patients to ensure optimal recovery and prevent second cardiovascular events. Healthcare facilities and policymakers should embrace this finding for a broader application of CR facilities and increased access. For example, facilities can significantly streamline the design and delivery process, focusing specifically on issues that could complicate access, such as long distances from medical institutions or physical limitations. On the one hand, shifting to home-based and hybrid delivery models has become a typical phenomenon among providers. PICO(T) Questions and an Evidence-Based Approach
On the other hand, it gives a new dimension to reach a more significant number of people. Modifications of those approaches lead to the need for policymakers to rethink healthcare system plans, including insurance inclusion of remote rehabilitation services. Furthermore, the literature revealed that CR should begin early and patient-centered care. Therefore, such findings can become a crucial platform for the arrival of new guidelines and the improvement of the current protocols for cardiac rehabilitation (Basognano, 2023). Hence, such data provides a basis for future research and practice guideline changes. Ensuring better program outcomes and broader availability for AMI patients is necessary.
Conclusion
The exploration of PICO(T) questions using an evidence-based approach gives a great deal of evidence for the influence of cardiac rehabilitation programs after AMI. The effects of these treatments are undoubtedly beneficial, decreasing mortality and recurrent CV events, highlighting their importance in improving patient outcomes rather than standard post-AMI treatment. Integrating exercise-based interventions alongside psychosocial and educational ones improves patients’ lifestyle and physical capacity, which conventional care methods cannot compare. This finding is the basis for changes in clinical practices that advocate for including comprehensive cardiac rehabilitation as a mandatory part of routine post-AMI care. These modifications could signify a significant shift in patient recovery patterns and the overall outcome of the healthcare system, demonstrating the potency of the evidence-based approach in clinical decision-making and policy formulation. The peer-evaluated data from scholarly sources, including Dibben et al. (2021) and Bruneau (2020), strengthens the approach and touches upon the skills needed to be developed or further enhanced in cardiac health services provision. PICO(T) Questions and an Evidence-Based Approach
References
Basognano, J. B. (2023). A new era in cardiac rehabilitation delivery: Key points. American College of Cardiology. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2023/01/25/17/06/a-new-era-in-cardiac-rehabilitation
Bruneau, J. E. E. (2020, May 1). The development and evaluation of the cardiovascular assessment screening program. Research.library.mun.ca. https://research.library.mun.ca/14388/
Darvishzadehdaledari, S., Harrison, A., Gholami, F., & Arian Azadnia. (2023). Examining the effectiveness of home-based cardiac rehabilitation programs for heart failure patients with reduced ejection fraction: A critical review. BMC Cardiovascular Disorders, 23(1). https://doi.org/10.1186/s12872-023-03640-x
Dibben, G., Faulkner, J., Oldridge, N., Rees, K., Thompson, D. R., Zwisler, A.-D., & Taylor, R. S. (2021). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, 2021(11). https://doi.org/10.1002/14651858.cd001800.pub4
Schon, C., Felismino, A., de Sá, J., Corte, R., Ribeiro, T., & Bruno, S. (2024). Efficacy of early cardiac rehabilitation after acute myocardial infarction: Randomized clinical trial protocol. PloS One, 19(1), e0296345–e0296345. https://doi.org/10.1371/journal.pone.029634 PICO(T) Questions and an Evidence-Based Approach
