A Motivational Telephone Intervention to Reduce Early Dropouts in Cardiac Rehabilitation

Abstract

Purpose: Cardiac rehabilitation (CR) improves outcomes, yet early dropout is common. The purpose of the study was to determine whether a motivational telephone intervention among patients at risk for nonadherence would reduce early dropouts. Methods: We performed a randomized double-blind pilot study with the intervention group receiving the telephone intervention 1 to 3 d after outpatient CR orientation. The control group received the standard of care, which did not routinely monitor attendance until 2 wk after orientation. The primary outcome was the percentage of patients who attended their second exercise session as scheduled. Secondary outcomes included attendance at the second CR session at any point and total number of sessions attended. Because not everyone randomized to the intervention was able to be contacted, we also conducted a per-protocol analysis. Results: One hundred patients were randomized to 2 groups (age 62 ± 15 yr, 46% male, 40% with myocardial infarction) with 49 in the intervention group. Patients who received the intervention were more likely to attend their second session as scheduled compared with the standard of care (80% vs 49%; relative risk = 1.62; 95% CI, 1.18-2.22). Although there was no difference in total number of sessions between groups, there was a statistically significant improvement in overall return rate among the per-protocol group (87% vs 66%; relative risk = 1.31; 95% CI, 1.05-1.63). Conclusions: A nursing-based telephone intervention targeted to patients at risk for early dropout shortly after their CR orientation improved both on-time and eventual return rates. This straightforward strategy represents an attractive adjunct to improve adherence to outpatient CR.

Patient Adherence to Therapy After Myocardial Infarction: A Scoping Review

“…A detailed overview of the characteristics of and key outcomes from the 13 articles is provided in Tables 2 and 4 respectively. Five randomized control studies were conducted in USA 11,13,15,16 and three in Iran, 12 Denmark, 14 China 18 (Tables 2 and 3).…”

“…In the studies the authors quite often used a non-experimental design (Table 2). 6 studies were randomized controlled trials, 2 of which were double-blind 11 and without blinding. 12 One study was conducted using a retrospective design (analysis of national stationary sample databases) 13 and the other study was a cohort design based on a nationwide registry.…”

“…Two studies (Table 2) used telephone intervention to improve patient adherence after myocardial infarction. 11,15 The studies show that behavioral economicsbased motivational telephone interventions targeting patients at risk of early study dropout shortly after targeting cardiac rehabilitation improve both timeliness and potential patient return rates and represent an adjunct to outpatient adherence. 11 The positive effect of telephone observation under the supervision of nurses was noted as a method of remote care for patients after myocardial infarction, which improves adherence to drug therapy and diet.…”

“…11,15 The studies show that behavioral economicsbased motivational telephone interventions targeting patients at risk of early study dropout shortly after targeting cardiac rehabilitation improve both timeliness and potential patient return rates and represent an adjunct to outpatient adherence. 11 The positive effect of telephone observation under the supervision of nurses was noted as a method of remote care for patients after myocardial infarction, which improves adherence to drug therapy and diet. 12 Behavioral economics-based telemedicine intervention improved adherence to low-dose aspirin treatment in patients after hospitalization for acute coronary syndrome.…”

Efeito de um programa educativo na realização de atividade física em indivíduos submetidos à primeira intervenção coronária percutânea: ensaio clínico aleatorizado

“…Autores, que utilizaram o acompanhamento telefônico como intervenção em pessoas com DAC, também encontraram resultados satisfatórios na avaliação do estado de saúde percebido (ALSALEH; WINDLE;BLAKE et al, 2016), na promoção do autocuidado (KAO et al, 2015) e, inclusive, no incremento da taxa de adesão da RC ambulatorial (LAVALLEY et al, 2019). Neste estudo, não foi realizada medida direta sobre a eficácia das ligações na intervenção implementada, mas buscamos estreitar o vínculo entre terapeuta e participante desenvolvido desde o primeiro contato e mantido pelas ligações, juntamente com o apoio social e emocional oferecidos ao participante e sua família.…”