Patient factors associated with enrollment, adherence, and change in cardiac risk factors among cardiac rehabilitation patients in Qatar

Abstract

Background: Cardiovascular disease is the number one killer in Qatar1. Cardiac rehabilitation (CR) is a secondary prevention model of care for cardiac patients. It is well-documented that CR reduces cardiovascular morbidity and mortality by 20%2. However, CR is underutilized worldwide, with low enrolment and adherence rates3. This study aims to investigate factors associated with enrolment and adherence, and to examine the relationship between adherence and change in cardiac risk factors. Methods: There were 714 cardiac patients, aged ≥ 18 years, referred to a CR program in Qatar. Retrospective cohort study using data from (January 2013-September 2018) were analyzed. Logistic regression models were used to assess factors associated with enrolment, adherence, and predictors of adherence. A paired sample t-test was used to identify mean change in cardiac risk factors: body mass index, low-density lipoprotein, high-density lipoprotein and total cholesterol) pre/post-CR. An independent sample t-test was used to identify change between groups (adherents vs. non-adherents). Results: The majority of our patients were males (n = 641, 89.8%) and non-Qatari (n = 596, 83.5%), i.e., similar to the Qatar population profile of 75% males and 15% Qatari, one fourth were smokers (n = 185, 25.91%), and one fifth (n = 128, 18.8%) were diagnosed with severe depression. Significant patient factors positively associated with enrolment (p < 0.05) were nationality, percutaneous coronary intervention (PCI), coronary artery bypass grafting, and coronary artery disease (Table 1). The number of sessions attended by patients is shown in Figure 1. Patients with American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) moderate and high-risk levels were more likely to adhere compared to those with low risk. Percutaneous coronary intervention (PCI) and musculoskeletal disease were negatively associated with adherence (Table 1). We found clinically significant health improvements among adherents compared to non-adherents; reduction of 10% in cholesterol, and 15% in LDL (low-density lipoprotein). Conclusion: This study provides new insights into the factors that lead patients to enrol in and adhere to CR in the Qatar setting. These factors represent opportunities for targeted interventions to improve CR utilization.