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

• 作者: Camila Ibara Carlos Navarrete Cinthia Casasbellas Dominique Guidi Giovanna Valentino Lorena Orellana Marcela Adasme Marcelo Fernández María José Bustamante Mónica Acevedo Verónica Kr?mer
• 来源期刊: 临床医学国际期刊(英文)
• 学科: 医学
• 关键词: CARDIAC REHABILITATION ADHERENCE SECONDARY Prevention
• 年，卷（期）: 2015,（9）
• 页码范围: 605-614
• 页数: 10页
• 分类号: R73

摘要

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.