Patient Adherence to a Cardiovascular Rehabilitation Program: What Factors Are Involved?

María José Bustamante,Giovanna Valentino,Mónica Acevedo,Marcelo Fernández,Verónica Krämer,Marcela Adasme,Carlos Navarrete,Lorena Orellana,Dominique Guidi,Camila Ibara,Cinthia Casasbellas

doi:10.4236/ijcm.2015.69081

María José Bustamante, Giovanna Valentino + Show 9 more

Open Access

https://doi.org/10.4236/ijcm.2015.69081

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Abstract

Background: Phase II cardiac rehabilitation (CR) is a class IA indication in patients suffering a cardiovascular event (CV). Current guidelines suggest 36 exercise sessions over a period of 3 months. The main aim of this study was to analyze the rate of adherence to a cardiac rehabilitation program and the factors influencing it. Methods: This was a cross-sectional study in 421 secondary prevention patients, who assisted to a Phase-II-CR program between 2007 and 2014. At baseline and program end, patients completed a 6-minute walk test and the Short-Form 36 Health Survey (SF-36). Vital signs and anthropometric measurements were also collected. Adherence was quantified as the percentage of individuals who attended all 36 sessions of the program. Factors considered for affecting adherence included: cardiovascular risk factors (RFs), type of health insurance (public or private), aerobic capacity, and SF-36 score parameters. Results: Adherence to Phase-II-CR was 33%, with no significant differences between men and women. The regression model fully adjusted for age, sex, RFs, type of health insurance and SF-36 score, showed that a SF-36 score <50 on physical health (odds ratio (OR): 11.47; 3.99 - 32.99; p < 0.0001) and smoking (OR: 4.41; 1.25 - 15.62; p = 0.02) were strong predictors for non-adherence. A trend for better adherence was observed in subjects older than 50 years compared to those aged between 17 and 50 years (37% versus 23%, respectively; p = 0.05). No significant differences were observed in adherence according to RFs clustering. Conclusions: Adherence to Phase-II-CR is low in our population. Patient-related factors, such as SF-36 score and smoking, were the best determinants of Phase-II-CR adherence. Health system-related factors did not influence adherence in this population. Prospective studies are warranted to determine all the factors which may influence adherence to Phase-II-CR programs.

Highlights

Cardiovascular disease (CVD) is the most common cause of death in Chile and is responsible for 27% of total deaths
35% of all cardiovascular event (CV) deaths are due to acute myocardial infarction (MI) [1] and the rate of MI mortality has remained steady in recent years, its incidence in the younger population has increased significantly [2]
Cardiovascular rehabilitation (CR) programs are associated with a reduction in CVD morbidity and mortality as well as improvements in the control of cardiovascular risk factors (RFs), exercise tolerance, control of anxiety and stress, and quality of life, among others [3]-[6]

Summary

Introduction

Cardiovascular disease (CVD) is the most common cause of death in Chile and is responsible for 27% of total deaths. Recent studies have demonstrated a dose-response relationship in CR (i.e., the greater the adherence to the program, the lower the CVD morbidity and mortality) [8] [9] Despite these benefits, participation in CR programs remains low, with only 10% to 20% of patients who survive an MI entering a secondary prevention program [8] [10]. The reasons for poor adherence to and underutilization of CR appear to be multifactorial: the patient’s age, income, distance from the health center, and personal beliefs of referring physicians about the benefits of Phase-II-CR are among some of the related factors [10] [12]-[14] Patient specific factors, such as cardiovascular RFs and RF clustering, may influence adherence to this treatment.

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