Abstract
Although cardiac rehabilitation (CR) is clearly beneficial to improving patients’ physical functioning and reducing heart disease progression, significant proportions of patients do not complete CR programs. To evaluate the prevalence and predictors of completion of a center-based CR program in eligible cardiac patients, existing data collected from electronic medical records were used. To identify the predictors of CR completion, we used principal components analysis (PCA) and an artificial neural network (ANN) module. Among 685 patients, 61.4% (n = 421) completed the program, 31.7% (n = 217) dropped out, and 6.9% (n = 47) were referred but failed to initiate the program. PCA was conducted to consolidate baseline data into three factors—(1) psychosocial factors (depression, anxiety, and quality of life), (2) age, and (3) BMI, which explained 66.8% of the total variance. The ANN model produced similar results as the PCA. Patients who completed CR sessions had greater extremity strength and flexibility, longer six-minute walk distance, more CR knowledge, and a better quality of life. The present study demonstrated that patients who were older, obese, and who had depression, anxiety, or a low quality of life were less likely to complete the CR program.
Highlights
Cardiovascular disease (CVD) is the leading cause of mortality and morbidity, and has a rising clinical and economic burden worldwide [1,2]
principal components analysis (PCA) can highlight the common variation between the original variables to condense the data, identifying the most relevant principal components to explain cardiac rehabilitation (CR) utilization status (Graduate, Dropout, and Referral)
Our results identified the input layer comprised of seven neurons, which validated the findings generated from PCA
Summary
Cardiovascular disease (CVD) is the leading cause of mortality and morbidity, and has a rising clinical and economic burden worldwide [1,2]. In management of CVD, cardiac rehabilitation (CR) is the standard treatment to promote lifestyle changes and modify risk factors for many CVD patients [3]. Association promotes the importance of referring appropriate patients to CR and recognizes this aspect of care in their clinical practice guidelines [11,12]. The benefits of CR are dependent on the patient’s long-term adherence to the program; among those who participate, 43% to 51% drop out within six months and up to 90% fail to complete one year [16,17]. CR incompletion rates vary in different studies and might be influenced by patient characteristics, psychological factors, social support, logistical issues, financial constraints, etc. The primary aim of the present study was to identify factors associated with
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