Cardiac rehabilitation in patients who underwent primary percutaneous coronary intervention for acute myocardial infarction: determinants of programme participation and completion

Abstract

BackgroundHospital length of stay after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (pPCI) has reduced, resulting in more limited patient education during admission. Therefore, systematic participation in cardiac rehabilitation (CR) has become more essential. We aimed to identify patient-related factors that are associated with participation in and completion of a CR programme.MethodsWe identified 3,871 consecutive AMI patients who underwent pPCI between 2003 and 2011. These patients were linked to the database of Capri CR, which provides dedicated, multi-disciplinary CR. ‘Participation’ was defined as registration at Capri CR within 6 months after pPCI. CR was ‘complete’ if a patient undertook the final exercise test.ResultsIn total, 1,497 patients (39%) were registered at Capri CR. Factors independently associated with CR participation included age (<50 vs. >70 year: odds ratio (OR) 7.0, 95% confidence interval (CI) 5.1–9.6), gender (men vs. women: OR 1.9, 95% CI 1.3–1.8), index diagnosis (ST-elevation myocardial infarction [STEMI] vs. non-ST-elevation myocardial infarction [NSTEMI]: OR 2.4, 95% CI 2.0–2.7) and socio-economic status (high vs. low: OR 2.0, 95% CI 1.6–2.5). The model based on these factors discriminated well (c-index 0.75). CR programme completion was 80% and was inversely related with diabetes, current smoking and previous MI. The discrimination of the model based on these factors was poor (c-index 0.59).ConclusionsOnly a minority of AMI/pPCI patients participated in a CR programme. Completion rates, however, were better. Increased physician and patient awareness of the benefits of CR are still needed, with focus on the elderly, women and patients with low socio-economic status.

Predictors of cardiorespiratory fitness improvement in phase II cardiac rehabilitation

“…Similar to prior studies, diabetes proved again to be a negative factor when it comes to functional benefit from CR . This may stem from the fact that patients with diabetes are less likely to be enrolled in CR, and less likely to be adherent . Another possible explanation is lower baseline fitness.…”

“…There was also no difference when it came to gender, since both male and female patients appeared to benefit in our study. Although that is an encouraging finding, women were still under‐represented in our study (29%), which is more of a reflection of poor enrollment of women in our and other CR programs across the country …”

“…Although that is an encouraging finding, women were still under-represented in our study (29%), which is more of a reflection of poor enrollment of women in our and other CR programs across the country. [20][21][22] Another unexpected yet encouraging finding was that CRF improvement was not related to baseline functional status. This is contrary to some data including from the APPROACH investigators and a recent study of >10 000 patients that showed mean baseline METs was among the strongest predictors of CRF improvement.…”

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“…Specifically in women, where the benefits are consistently the same as in men they remain of low representative in most studies, with only 15% to 25%, presenting themselves with more risk factors and probably more severe CHD 9,24,29,30 One study found that the probability of women engaging in CR program was 7.1% lower than men. 24 In a study with 3,871 patient, where 1,497 39%) engaged CR program and 1,193 completed it, the chance of completing CR program after primary PCI for acute MI was evaluated.…”

“…24 In a study with 3,871 patient, where 1,497 39%) engaged CR program and 1,193 completed it, the chance of completing CR program after primary PCI for acute MI was evaluated. Sunamura et al 29 found that elderly, female and low socioeconomic status patients were at increased risk of non-participation and non-completion of CR. They also found that patients with diabetes, current smokers and with history of prior MI were at risk of not completing the program.…”