Abstract
Background
Cardiac rehabilitation (CR) assists patients with cardiovascular disease (CVD) in improving physical activity and effectively managing their health conditions. With numerous clinical benefits including reduced risks of mortality (by 25%) and all-cause hospitalizations (by 18% - 25%), CR has been strongly recommended by evidence-based clinical guidelines for secondary prevention of CVD. However, many CR participant withdraw and hence fail to fully benefit from their CR programme. To address this issue, knowledge on risk stratification of patients' characteristics to appropriate CR care pathways is important.
Purpose
The purpose of this study is to identify clinical baseline characteristics associated with patients who withdraw from a CR programme.
Methods
We retrospectively analysed patients who participated in the centre-based CR programmes of a research study in Queensland, Australia. The CR programmes provided structured sessions (training and education) once or twice a week for six weeks in community care centres. We compared the patients who withdrew from their CR programme (Group-W) with those who did not withdraw (or simply completion) (Group-C). Withdrawal was defined as discontinuing within the first four weeks of the CR programme. In the comparison, the one-way analysis of variance (ANOVA) and Fisher's exact test were used for analysing age and sex respectively. The analysis of covariance (ANCOVA) with an adjustment for age and sex was used for the body mass index (BMI), six-minute walk test (6WMT), and health-related quality of life (HeartQoL, ESC 2012), comprising physical (HeartQoL-Phy), emotional (HeartQoL-Emo), and global (HeartQoL-Glo) subscales. The study was approved by the Human Research Ethics Committee (Reference: HREC/16/QPAH/636).
Results
From Dec 2016 to Dec 2017, 600 outpatients with CVD were consented, and enrolled in the study. Seventy participants withdrew. Between the two groups (Group-W vs Group-C), no significant differences were found in age (64±12 years vs 65±10 years; p=0.4221), sex (Female, 31% vs 25%; p=0.2461) and BMI (30.5±6.2 vs 30.1±11.2; p=0.8211). The 6MWT distance was significantly lower in Group-W than Group-C (346±103 m vs 394±92 m; p=0.001). Significantly lower scores of HeartQoL-Phy (1.66±0.86 vs 1.93±0.74; p=0.0072) and HeartQoL-Glo scores (1.80±0.78 vs 2.02±0.67; p=0.0205) were found in Group-W. HeartQoL-Emo scores were lower in Group-W but the difference was not significant (2.19±0.73 vs 2.28±0.72; p=0.4550).
Conclusions
The levels of functional capacity measured by 6MWT and physical activity related quality of life were found to be significantly lower in withdrawal patients than those who completed their CR programme. The finding indicates that new care strategies, especially for patients with limited functional capacity and physical activity, are needed to improve the adherence and effectiveness of CR intervention in future studies.
Acknowledgement/Funding
CSIRO and Metro South Health
Socioeconomic Status and Improvements in Lifestyle, Coronary Risk Factors, and Quality of Life: The Multisite Cardiac Lifestyle Intervention Program