Nonparticipation in Cardiac Rehabilitation

Factors that predict compliance in a virtual cardiac rehabilitation program

BACKGROUND

Despite the well-established benefits of cardiac rehabilitation (CR) for patients with cardiovascular disease (CVD), participation in CR remain low. Virtual CR programs present a unique opportunity to promote utilization. To date, few virtual CR cohorts have been analyzed for compliance. This study aims to determine factors that predict compliance within a large virtual CR program in the United States.

METHODS

We analyzed 1409 patients enrolled in the Kaiser Permanente Mid-Atlantic States Virtual CR program that consists of 12 CR sessions via telephone. Demographic characteristics, as well as body weight, blood pressure, HbA1c level, and smoking status were collected at admission. Patients were further classified by CVD diagnosis codes. Compliance was defined as at least 75% (9/12 sessions) attendance. Data was analyzed using simple and multiple regression models with significance defined as P < 0.05.

RESULTS

Age was the single strongest predictor for virtual CR compliance (adjusted R2 = 0.58; P < 0.001), and non-compliant patients were younger. HbA1C level, CVD diagnosis codes, and smoking status each moderately predicted compliance (adjusted R2 = 0.48, 0.42, and 0.31, respectively; P < 0.001). Smoking and HbA1C level combined in a multiple regression model significantly improved prediction of compliance (adjusted R2 = 0.79, P < 0.01). Sex, baseline weight or hypertension were not significant predictors of CR compliance.

CONCLUSIONS

Age, diabetes, CVD diagnoses, smoking status at admission are independent predictors of compliance in a large virtual CR program. Targeted intervention could be designed accordingly to improve CR compliance.

A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change

BACKGROUND

Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes.

METHODS

A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework.

RESULTS

374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes.

CONCLUSION

There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support.

Preliminary evidence for the construct and concurrent validity of the DS14 in Hebrew

BACKGROUND

Type D personality is a risk indicator in cardiac patients. While both the validity and reliability of the Type D scale (DS14) have been confirmed in Western Europe, less attention has been paid to the subject in other nations.

PURPOSE

The purpose of this study was to examine the validity of the Hebrew version of the DS14 among a sample of cardiac patients in Israel.

METHOD

Male patients (N = 94) hospitalized for a first acute coronary syndrome (ACS) completed the DS14 1 month after their ACS. The Brief Symptoms Inventory (BSI) scales for depression and anxiety and the Buss-Durkee Hostility Inventory-Dutch for measuring covert and overt aggressions were administered during the initial hospitalization (baseline). The BSI was administered again at the 6-month follow-up. At follow-up, patients were also asked about their participation in a formal cardiac rehabilitation program.

RESULTS

The two-factor structure of the DS14 was confirmed and the DS14 subscales were internally consistent (Cronbach's α = 0.79/0.80). Type D cardiac patients had a significantly higher mean score on anxiety, depression, and covert aggression at baseline compared to non-Type D patients. At the 6-month follow-up, Type D was associated with more anxiety, more depression, and less attendance at a formal cardiac rehabilitation program. The prevalence of Type D in the current sample (5.3%) was found to be significantly lower than elsewhere in Europe.

CONCLUSION

Preliminary evidence suggests that it is possible to use the Hebrew version of the DS14 among Hebrew-speaking cardiac patients in future studies. However, the prevalence of the Type D personality in Israel should be further assessed.

Development and preliminary testing of the Cardiac Rehabilitation Enrolment Obstacles (CREO) scale: implications for service development

BACKGROUND

In spite of the benefit in participating in cardiac rehabilitation (CR) programs, low participation rates are well documented. Participation rates are potentially lower in people who have undergone percutaneous coronary interventions (PCI). Assessment of the barriers to CR participation in PCI patients could provide vital information for the development of alternate strategies for coronary risk factor modification.

AIM

The aim of this study was to develop and evaluate the psychometric properties of a scale to assess obstacles to cardiac rehabilitation enrolment in patients following PCI.

METHODS

Item generation for the 15 items of this scale was based on a comprehensive review of the literature and data collected from telephone interviews of CR coordinators related to cardiac rehabilitation enrolment obstacles (CREO). Content validity of the scale was undertaken using a reference group comprising of clinicians and patients. Construct validity was undertaken using a factor analysis. Data for the CREO scale was collected from December 2004 to March 2005 from 114 PCI patients recruited from a cardiology database in a Sydney metropolitan hospital.

RESULTS

Factor analysis revealed a two-factor structure: patient-related obstacles and health service-related obstacles, which accounted for 58% of cumulative explained variance. The scale showed good internal consistency (Cronbach's alpha=0.89) and satisfactory divergent validity.

CONCLUSION

This scale can be used as a useful tool for the early identification of patients who would not normally enrol into CR and offer them alternate strategies for health-related lifestyle modification.