Cardiac Rehabilitation Adherence Research Articles

Predictors of Health-Related Quality of Life Among Women Participating in an Appointment-Based Cardiac Rehabilitation Program.

An alternative patient-centered appointment-based cardiac rehabilitation (CR) program has led to significant improvements in health outcomes for patients with cardiovascular disease. However, less is known about the effects of this approach on health-related quality of life (HRQoL), particularly for women. We examined the effects of a patient-centered appointment-based CR program on HRQoL by sex and examined predictors of HRQoL improvements specifically for women. Data were used from an urban single-center CR program at Yale New Haven Health (2012-2017). We collected information on patient demographics, socioeconomic status, and clinical characteristics. The Outcome Short-Form General Health Survey (SF-36) was used to measure HRQoL. We evaluated sex differences in SF-36 scores using t tests and used a multivariate linear regression model to examine predictors of improvements in HRQoL (total SF-36 score) for women. A total of 1530 patients with cardiovascular disease (23.7% women, 4.8% Black; mean age, 64 ± 10.8 years) were enrolled in the CR program. Women were more likely to be older, Black, and separated, divorced, or widowed. Although women had lower total SF-36 scores on CR entry, there was no statistically significant difference in CR adherence or total SF-36 score improvements between sexes. Women who were employed and those with chronic obstructive pulmonary disease were more likely to have improvements in total SF-36 scores. Both men and women participating in an appointment-based CR program achieved significant improvements in HRQoL. This approach could be a viable alternative to conventional CR to optimize secondary outcomes for patients.

The impact of secondary prevention methods on medication adherence in cardiac rehabilitation of patients after catheter ablation: a Prospective Study

INTRODUCTION. Medication non-adherence is one of the significant public health issue. Low adherence is one of the main reasons for the decrease therapeutic effect in patients with atrial fibrillation (AF), development of complications of AF, which leads to poor health outcomes and increased healthcare costs. Secondary prevention programs in cardiac rehabilitation may improve medication adherence in patients with AF.
 AIM. To assess the impact of secondary prevention methods on medication adherence in patients after catheter ablation (CA) performed for paroxysmal AF.
 MATERIALS AND METHODS. This is a prospective randomized controlled study with 3 parallel groups of patients with paroxysmal AF after CA (radiofrequency or cryoablation). Patients were randomized into 3 groups in 1:1:1 ratio. The 2 intervention groups received secondary prevention methods, including single-session in-person counseling and for 3 months of distant support (by phone in Group 1 or by e-mail in Group 2). Group 3 received usual care. Medication adherence was assessed using the 4-question scale Moriscos-Green. The medication adherence was evaluated at baseline and 12 months after CA.
 RESULTS AND DISCUSSION. A total of 135 patients aged 35 to 79 years were enrolled (mean age 57 9 years, 51,8 % men). At 1 year of follow-up patients from intervention group experienced significant improvement of medication adherence (p = 0,006 for Group 1 и 2) vs control.
 CONCLUSION. Secondary prevention methods with remote support improve the medication adherence in AF pts after CA which may positively affect on their health.

The Feasibility and Effects of Smartphone-Based Application on Cardiac Rehabilitation for Patients After Percutaneous Coronary Intervention: A Randomized Controlled Trial.

Cardiac rehabilitation (CR) referral and participation are generally found to be underused worldwide. The data in Asian regions suggest significant underutilization compared with western countries. To promote the continuity and effects of CR, this study aimed at supporting self-care and improving CR effects in phase II CR with mobile health application for Macao patients who have undergone percutaneous coronary intervention. The study was a randomized controlled trial conducted between January 2018 and June 2020 in a nongovernmental Hospital. Social cognitive theory was applied in the intervention for an experimental group. Measurements including anxiety and depression level, medication adherence, exercise capacity, physical activity level, cardiovascular risk modification, self-efficacy, quality of life, use of healthcare resources, mHealth CR utility, and satisfaction were analyzed. One hundred forty eligible patients were recruited, and 110 patients completed the study. Significant interventional effects of the experimental group were found on the reduction of total cholesterol, low-density lipoprotein, sitting time, anxiety level, and total anxiety and depression level ( P < .05). In addition, significant improvement on the 6-minute walk test, regular exercise performance, self-efficacy of cardiac exercise and diet, and quality of life were found as interventional effects in the experimental group ( P < .05). The feasibility of intervention was achieved in a satisfactory level. This theoretically grounded mobile health CR study was a unique program tailor-made to meet the care needs of patients post percutaneous coronary intervention. It was feasible and effective to support CR effects and adherence and would inform further design of clinical practice and public policies.

Cardiac rehabilitation utilization, barriers, and outcomes among patients with heart failure.

Exercise-based cardiac rehabilitation (CR) is effective for improving both primary (i.e., mortality and hospitalizations) and secondary (i.e., functional capacity and quality of life among) clinical outcomes among patients with heart failure (HF). The mechanisms that explain these benefits are complex and are linked to exercise adaptations such as central and peripheral hemodynamics combined with improved overall medical management. Despite the benefits of CR, utilization rates are low among CR eligible patients. Clinician-, patient-, and health system-related barriers have been identified as primary factors contributing to the lack of CR utilization among HF patients. These include patient referrals (clinician-related), psychosocial factors (patient-related), and patient access to CR services (health system-related). The aims of this review are to detail the components of each barrier as well as identify evidence-based strategies to improve CR utilization and adherence among HF. The improvements in primary and secondary outcomes along with the mechanisms that are linked to these changes will also be examined.

Cardiac rehabilitation adherence: A multifaceted approach

Cardiac rehabilitation programs are crucial components of cardiac care, aiming to optimize the recovery of patients after cardiac surgery. Within these programs, physiotherapists play a pivotal role in guiding patients through exercise regimens, lifestyle modifications, and the management of pharmacotherapy. Despite their essential role, there remains a limited exploration of the knowledge, attitude, and practice of physiotherapists concerning cardiac rehabilitation program adherence, with a particular focus on the integration of pharmacotherapy, among patients discharged from Indian hospitals after cardiac surgery. This study conducted a structured analysis to comprehensively assess physiotherapists’ knowledge of cardiac rehabilitation guidelines, their attitudes toward patient adherence, and their practices in promoting adherence, taking into consideration the pharmacotherapeutic aspect. Preliminary findings reveal that a substantial proportion of physiotherapists possess an adequate knowledge of cardiac rehabilitation guidelines, emphasizing the significance of exercise, risk factor management, psychosocial support, and medication management. Attitudes toward patient adherence were predominantly positive, reflecting a strong belief in the program’s efficacy in improving patient outcomes. However, it is noteworthy that certain barriers to adherence, including patient motivation, resource limitations, and cultural factors, were identified. In practice, physiotherapists employ diverse strategies, encompassing patient education, exercise supervision, goal setting, and pharmacotherapeutic guidance, to enhance adherence among discharged patients. This review provides valuable insights into the knowledge, attitude, and practice of physiotherapists concerning cardiac rehabilitation program adherence, emphasizing the integration of pharmacotherapy, among patients following cardiac surgery in India. While physiotherapists exhibit robust knowledge and positive attitudes, challenges related to patient motivation and resource constraints warrant dedicated attention. These findings underscore the imperative need for targeted interventions and resource allocation to enhance adherence to cardiac rehabilitation programs, ultimately contributing to improved postoperative outcomes for cardiac surgery patients in India. Furthermore, further research is essential to explore the patient perspective comprehensively and establish a holistic approach to cardiac rehabilitation adherence that seamlessly incorporates pharmacotherapy.

Cultural influences on adherence to cardiac rehabilitation programmes: perspectives from South Asian healthcare professionals

Background/Aims Health disparities concerning uptake of and adherence to cardiac rehabilitation post-myocardial infarction have been observed in patients with coronary heart disease from a South Asian background. Healthcare professionals from a South Asian background can provide insight into the influential cultural factors affecting cardiac rehabilitation adherence. The aim of the study was to explore cultural factors impacting adherence to cardiac rehabilitation post-myocardial infarction from the perspective of healthcare professionals from a South Asian background. Methods A qualitative thematic approach using semi-structured interviews was employed with 15 participants (8 men and 7 women) recruited from various healthcare settings. The participants were from a range of health professions, including a physiotherapist, general practitioner, nurse, surgeon, physiologist, cardiologist and pharmacist. Results Four themes were identified from the interviews: familiarity: influence of practitioners' own cultural background; Western vs Eastern medical philosophy: generation and gender influences; engaging with existing services: changing patients' attitudes and perceptions; and modifying practitioner–patient communication: encouraging patient responsibility. All themes related to health beliefs that patients from a South Asian background were perceived to hold. Conclusions Previous research has suggested that there is a need to tailor health services towards people from a South Asian background. However, the focus should also simultaneously be on changing patients' perceptions of their own health and to consider providing outpatients with the support to develop the necessary skills to implement lifestyle changes towards improving cardiac rehabilitation uptake and adherence.

The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial

BackgroundAdherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA).MethodA pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed.ResultPatients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05).ConclusionThis study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes.

Implementation of an Appointment-Based Cardiac Rehabilitation Approach: A Single-Center Experience.

BackgroundThere has been a focus on alternative cardiac rehabilitation (CR) delivery models aimed at improving CR adherence and completion. We examined pre‐ and post‐CR health outcomes, reasons for discharge, and predictors of completion using a patient‐driven appointment‐based CR approach that uses center‐scheduled class start times.Methods and ResultsData were used from an urban single‐center CR program at Yale New Haven Health (2012–2017) that enrolled 2135 patients. We evaluated pre‐ and post‐CR outcomes (12 weeks) using paired t tests and used a multivariable logistic regression model to examine predictors of CR completion (≥36 sessions) for the overall cardiovascular disease population. The mean age of participants was 65±12 years, 27.9% were women, and 5.1% were Black patients, and patients completed a median of 30 of 36 sessions. Patients achieved significant improvements in health outcomes, including across age and sex subgroups. The primary reason for discharge was completion of all 36 sessions of CR (46.4%). The final logistic regression model contained 12 predictors: age, sex, Black race, marital status, employment, number of physician‐reported risk factors, dietary fat intake >30%, obesity, lack of exercise, benign prostatic hyperplasia, and self‐reported stress and physical activity.ConclusionsWe demonstrated that patients participating in an appointment‐based CR program achieved significant improvements in health outcomes and across sex/age subgroups. In addition, older individuals were more likely to complete CR. An appointment‐based approach could be a viable alternative CR method to aid in optimizing the dose‐response benefit of CR for patients with cardiovascular disease.

Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives.

Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.

Hybrid cardiac rehabilitation – The state of the science and the way forward

Cardiac rehabilitation (CR) improves exercise capacity and health-related quality of life (HRQoL) in a broad range of patients, including those with coronary artery disease, heart failure (HF), after heart valve surgery, and after heart transplantation. Unfortunately, in traditional center-based CR programs participation and adherence are low. A hybrid model of CR, combining center-based and home-based CR services, has been proposed and is currently being studied as a potential way to help bridge the participation gap, while maintaining the beneficial patient outcomes from CR. However, the ideal composition of a hybrid CR program has not been universally agreed upon. In the present review, we define hybrid CR as any combination of supervised center-based and monitored home-based exercise, where at least two of the core components of CR are addressed. Using this definition, we searched for studies comparing hybrid CR with: (1) traditional center-based CR among CAD patients, (2) usual care among CAD patients, and (3) usual care among HF patients. We found nine studies which fit both our definition and comparison groups. The structure of the hybrid CR programs differed for each study, but typically began with a center-based component lasting 2–11 weeks and transitioned to a home-based component lasting 10–22 weeks, with 3–5 exercise sessions per week composed of either walking (usually with a treadmill) or cycling for 25–35 min at 60–75% maximal heart rate. Patients recorded data from home exercise sessions, via either a digital heart rate monitor or accelerometer, into logbooks which were reviewed by a therapist at specified intervals (often via telephone). Counseling on risk factor management was predominantly provided during the center-based component. In these studies, hybrid CR led to similar short-term outcomes compared to traditional CR in patients with coronary artery disease (CAD), as well as increased adherence and reduced delivery costs. Compared with usual care, in patients with CAD, hybrid CR reduced cardiovascular events, and improved lipid profiles, exercise capacity, and HRQoL. In patients with HF, compared with usual care, hybrid CR improved physical function, exercise capacity, and HRQoL. Ongoing studies may clarify the combination of center-based and home-based CR which produces superior outcomes, and may also better define the role that technology should play in CR interventions.

The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes.

Participating in cardiac rehabilitation (CR) after a cardiac event provides many clinical benefits. Patients of lower socioeconomic status (SES) are less likely to attend CR. It is unclear whether they attain similar clinical benefits as patients with higher SES. This study examines how educational attainment (one measure of SES) predicts both adherence to and improvements during CR. This was a prospective observational study of 1407 patients enrolled between January 2016 and December 2019 in a CR program located in Burlington, VT. Years of education, smoking status (self-reported and objectively measured), depression symptom level (Patient Health Questionnaire), self-reported physical function (Medical Outcomes Survey), level of fitness (peak metabolic equivalent, peak oxygen uptake, and handgrip strength), and body composition (body mass index and waist circumference) were obtained at entry to, and for a subset (n = 917), at exit from CR. Associations of educational attainment with baseline characteristics were examined using Kruskal-Wallis or Pearson's χ 2 tests as appropriate. Associations of educational attainment with improvements during CR were examined using analysis of covariance or logistic regression as appropriate. Educational attainment was significantly associated with most patient characteristics examined at intake and was a significant predictor of the number of CR sessions completed. Lower educational attainment was associated with less improvement in cardiorespiratory fitness, even when controlling for other variables. Patients with lower SES attend fewer sessions of CR than their higher SES counterparts and may not attain the same level of benefit from attending. Programs need to increase attendance within this population and consider program modifications that further support behavioral changes during CR.

Abstract 10546: Predictors of Changes in Peak Oxygen Consumption Following Outpatient Cardiac Rehabilitation: Importance of Cardiac Rehabilitation Adherence

Introduction: Cardiac rehabilitation (CR) is associated with improvements in exercise capacity (peak oxygen uptake (VO 2 peak)); however, 23% of CR patients do not improve VO 2 peak following CR. CR adherence (i.e. number of CR sessions attended) has been proposed to play an important role in VO 2 peak improvement following CR, but has not been investigated. Identifying clinical predictors of VO 2 peak improvement are critical as the degree of VO 2 peak improvement is associated with improved long-term outcomes in these patients. Purpose: To determine if clinical characteristics and number of CR sessions attended were predictive of patients who exhibited improvement in VO 2 peak following CR. Methods: Using the Rochester Epidemiology Project records-linkage system, we identified all consecutive patients &gt;18 years old from Olmsted County, Minnesota who underwent cardiopulmonary exercise testing prior to and following CR from 1999 to 2017. Regression models were created to assess clinical predictors of VO 2 peak improvement (&gt;0% baseline) following CR. Results: The analysis included 804 patients (75% men) with a mean age of 60.7±12.4 years. Of the 804 patients, 609 (76%) patients exhibited VO 2 peak improvement following CR. Significant univariate predictors of VO 2 peak improvement included younger age (OR: 0.99, 95% CI: 0.97-1.00), lower pre-CR VO 2 peak (OR: 0.97, 95% CI: 0.94-0.99), history of peripheral artery disease (OR: 0.48, 95% CI: 0.32-0.73), and smoking (OR: 0.63, 95% CI: 0.45-0.90). Significant independent predictors of VO 2 peak improvement from a multivariate analysis included younger age (OR: 0.98, 95% CI: 0.96-1.00), number of CR sessions (OR: 1.02, 95% CI: 1.01-1.03), lower pre-CR VO 2 peak (OR: 0.94, 95% CI: 0.91-0.96), history of peripheral artery disease (OR: 0.42, 95% CI: 0.27-0.66), and smoking (OR: 0.56, 95% CI: 0.39-0.82). Conclusions: These findings demonstrate the importance of CR adherence and individual clinical characteristics in influencing VO 2 peak improvement following CR in patients with CVD. These findings may influence the clinical practice by providing specific clinical characteristics to account for when personalizing the CR treatment plan to maximize positive outcomes.

Motivational Strategies and Concepts to Increase Participation and Adherence in Cardiac Rehabilitation: AN INTEGRATIVE REVIEW.

Low participation and adherence to cardiac rehabilitation (CR) leads to ineffective care and increased risk of cardiac complications. There is a need to identify effective motivational strategies and concepts to increase participation and adherence to CR. The aim of this review was to synthesize and integrate the current knowledge about motivational strategies and concepts to increase participation and adherence to CR. A literature search was performed using five electronic databases: CINAHL, Medline via PubMed, Scopus, Embase, and Rehabilitation & Sports Medicine Source. The search was limited to peer-reviewed studies, written in English, and publications from 2010 to 2019. A matrix and narrative synthesis were employed to organize and synthesize the findings, respectively. Eight of 522 articles met the inclusion criteria. Four articles used motivational interviewing (MotI) and counseling strategy, three articles investigated the autonomy, competence, and relatedness of self-determination theory (SDT) concepts, and one article used a reinforced motivational strategy. Use of MotI led to improving the CR completion rate from 14% to 39%. The number of sessions attended/patient improved from 12 to 20 when the staff was provided attendance feedback and a reward. Autonomy, competence, and relatedness motivated patients to participate in and adhere to CR. Motivational interviewing and counseling, motivational and reinforcement strategies, and the autonomy, competence, and relatedness of SDT concepts should be utilized to promote participation and motivation for CR. The effects of these techniques on long-term CR require further research, including combining the identified methods to investigate the efficacy of these techniques on CR adherence.

SEX DIFFERENCES IN THE IMPACT OF SYMPTOMS OF ANXIETY AND DEPRESSION ON CARDIAC REHABILITATION PARTICIPATION AND OUTCOMES

SEX DIFFERENCES IN THE IMPACT OF SYMPTOMS OF ANXIETY AND DEPRESSION ON CARDIAC REHABILITATION PARTICIPATION AND OUTCOMES

Is the Training Intensity in Phase Two Cardiovascular Rehabilitation Different in Telehealth versus Outpatient Rehabilitation?

Telehealth cardiac rehabilitation (CR) is a feasible and effective alternative to conventional outpatient CR. Present evidence is limited on the comparison of exercise intensity adherence in telehealth and outpatient CR. The purpose of the study was to evaluate and compare training intensity adherence through 12-week phase II CR in telehealth and outpatient CR. A sample of 56 patients with coronary artery disease (CAD) with a mean age of 56.7 ± 7.1 entering comprehensive secondary prevention phase II was randomized into telehealth CR (n = 28) and control outpatient CR (n = 28) groups. The primary outcome was a comparison of training intensity adherence in both CR models and heart rate (HR) response from individual CR sessions, expressed by the HR reserve percentage. As a result, the parameter HR reserve percentage as the total average of the training intensity during the telehealth intervention and the outpatient CR did not differ statistically (p = 0.63). There was no death case, and all severe adverse cases required medical admission throughout an exercise training session in study subjects in both groups. This research evidence demonstrated that the telehealth CR model is similar in training intensities to the conventional outpatient CR in CAD patients with low to moderate cardiovascular risk.

Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned.

Cardiac rehabilitation (CR) after hospitalization for acute coronary syndrome (ACS) has shown to reduce mortality, readmissions, and improve quality of life. CR is recommended by international guidelines but previous studies have shown low participation rates. Systematic CR referral might improve CR participation. The present study evaluates CR referral and CR participation of patients hospitalized for ACS in 2017 and treated according to local protocol, which includes systematic CR referral. Participation rate was divided into a group that finished the CR program and drop outs. In addition, factors associated with CR referral and participation rate were evaluated. A total of 469 patients eligible for CR were included in the study, of which 377 (80%) were referred for CR and 353 (75%) participated in CR. Ninety percent of participants completed the CR program. Factors independently associated with CR referral included age (50-60year vs.>70year: odds ratio [OR] 4.7, 95% confidence interval [CI] 1.98-11.2), diagnosis (ST-elevation myocardial infarction vs. unstable angina: OR 17.7, CI 7.59-41.7), previous cardiovascular disease (OR 0.4, CI 0.19-0.73) and left ventricular dysfunction vs. normal function (OR 2.2, CI 1.11-4.52). A larger distance to the CR center was associated with lower CR participation (<5km vs.>20km: OR 3.1, CI 1.20-7.72). Systematic CR referral in ACS patients results in high CR referral (80%) and participation (75%) rates. CR adherence might be further improved by increasing CR referral, especially in older patients and patients with NSTEMI or unstable angina.

Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study.

Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients. The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P < 0.001) and compliance (full compliance: 66.0% vs. 38.8%, P < 0.001) than extensive-outpatient programmes. In this European cohort of elderly patients, older age and comorbidity tackled patients' referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients.

Cardiac rehabilitation in women; comparison of enrollment, adherence and outcomes between heart failure and coronary artery disease

BackgroundThere is paucity of data on cardiac rehabilitation (CR) enrollment and outcomes in women with heart failure (HF). MethodsIn this retrospective analysis, we compared enrollment, adherence and outcomes between women with HF versus coronary artery disease (CAD)-related indications referred to a university-affiliated CR program from June 2014–July 2018. A multivariate regression analysis was performed to adjust for imbalanced variables at baseline and baseline value of each outcome to compare change in outcomes between HF and CAD groups ResultsA total of 538 women (HF=63 vs CAD=475) were included in the study. At baseline, women with HF were younger, had lower attendance to CR intake and worse perceived health, higher AACVPR risk category and lower exercise capacity but had similar enrollment, weight and dieatry habits when compared to women with CAD. Adjusted analyses showed that almost all cardiac rehabilitation outcomes except for positive affect (anxiety, depression symptoms, negative affect, dietary habits, perceived physical and mental health summary scores, exercise duration and capacity) improved significantly from baseline and in a similar fashion in both groups. Weight loss was significantly greater for women with CAD versus those with HF (CAD: Δ -1.12 ± 2.23 kg versus HF: Δ -0.66 ± 2.78 kg, p = 0.03). ConclusionDespite a lower attendance to CR intake, lower perceived physical health and higher baseline AACVPR risk in women with HF, they have similar CR enrollment, adherence and completion rates compared to women with CAD. Both groups showed significant but similar improvements from baseline in almost all cardiac rehabilitation outcomes. These findings should alert cardiology providers to help overcome obstacles for women with HF to attend CR intake.

Abstract 13631: Improving Cardiac Rehabilitation Attendance Through an Appointment-based Approach

Introduction: Cardiac rehabilitation (CR) is the pillar of secondary prevention for patients with cardiovascular disease (CVD). Despite its effectiveness, there remain systemic issues with adherence to in-clinic CR sessions, with the median number of CR sessions completed nationwide being 26 (out of a total of 36 sessions). We evaluated pre-post health outcomes for patients participating in a patient-driven appointment-based CR program, reasons for discharge, as well as predictors of total CR sessions attended. Methods: We utilized data from the Yale New-Haven Health (YNHH) CR program over a 6-year period (2012-2017). Data was collected on patient demographics, socio-economic status, and clinical characteristics. We evaluated CR outcomes with paired T-tests and conducted logistic regression analysis to determine predictors of CR adherence and completion. Results: A total of 2,135 patients were enrolled in CR from 2012 to 2017 (27.9% women, mean age 65±12 years). Patients completed a median of 30 sessions out of a total of 36. The primary reason for discharge was completion of all 36 sessions of CR (46.4%). The appointment-based CR program resulted in significant improvements in physical health outcomes (Table) , with matched-subject improvements of 1.42 METs increase, 0.32 kg/m 2 decrease in BMI and a 1.88% decrease in body fat percentage (P&lt;0.001). Patients also demonstrated improvements in blood pressure control, lipid profiles and diabetes management. Logistic regression modeling found that patient-specific medical factors, such as self-reported levels of stress and physical activity were predictive of CR completion. Conclusion: We demonstrated that an appointment-based CR program led to an increase in the median number of CR sessions completed versus the nationwide average, and produced significant improvements in health outcomes. Appointment-based CR could aid in optimizing the dose-response benefit of CR for patients with CVD.

How and why a multifaceted intervention to improve adherence post-MI worked for some (and could work better for others): an outcome-driven qualitative process evaluation

ObjectivesTo explore (1) the extent to which a multicomponent intervention addressed determinants of the desired behaviours (ie, adherence to cardiac rehabilitation (CR) and cardiovascular medications), (2) the associated mechanism(s) of...