Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction: The Perfect-CR study

Abstract

BackgroundBenefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI. MethodsIn this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg and smoking abstinence. ResultsThe strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78–2.50]; 2.45 [1.91–2.99]), having a psychologist in the CR team (1.62 [1.36–1.87]; 2.05 [1.67–2.44]), extended opening hours (2.13 [2.00–2.27]; 1.50 [0.91–2.10]), adequate facilities (1.54 [0.91–2.18]; 1.89 [1.38–2.40]), and having a medical director (1.70 [0.91–2.48]; 1.46 [1.04–1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39–4.51]) and having no history of hypertension (2.93 [2.60–3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66–2.10]; 1.46 [1.14–1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95–2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07–2.88]) and group education (1.92 [1.43–2-42]), and no cardiovascular disease history (2.13 [1.78–2.48]). ConclusionsWe identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.