Identifying Reasons for Nonattendance and Noncompletion of Cardiac Rehabilitation

Vonk, Thijs; Nuijten, Malou A H; Maessen, Martijn F.H.; Meindersma, Esther P.; Koornstra-Wortel, Hetty J J; Waskowsky, Marc M; Snoek, Johan A.; Eijsvogels, Thijs M. H.; Hopman, Maria T. E.

doi:10.1097/hcr.0000000000000580

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…The authors suggest a home-based and more personalized CR approach and a better patient education to enhance their motivation and adherence to CR programs. 23 Our data from the CR3 study confirm underutilization of CR measures while no severe adverse events would confirm a hazard from the device itself. The WCD may serve as a tool for prolonged CR measures in an outpatient setting, as former studies have tested the device to surveil a 6-min walking test.…”

Section: Discussionsupporting

confidence: 51%

Cardiovascular Rehabilitation With a WCD—Data From the CR3 Study (Cardiac Rehab Retrospective Review)

Rohrer,

Reischl,

Manninger

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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Purpose: Patients at risk for sudden cardiac death may temporarily need a wearable cardioverter-defibrillator (WCD). Exercise-based cardiac rehabilitation (CR) has a class I recommendation in patients with cardiac disease. The aim of this study was to evaluate the safety and feasibility of undergoing CR with a WCD. Methods: We performed a retrospective analysis of all patients with a WCD who completed a CR in Austria (2010-2020). Results: Patients (n = 55, 60 ± 11 yr, 16% female) with a median baseline left ventricular ejection fraction (LVEF) of 36 (30, 41)% at the start of CR showed a daily WCD wearing duration of 23.4 (22, 24) hr. There were 2848 (8 [1, 26]/patient) automatic alarms and 340 (3 [1, 7]/patient) manual alarms generated. No shocks were delivered by the WCD during the CR period. One patient had recurrent hemodynamically tolerated ventricular tachycardias that were controlled with antiarrhythmic drugs. No severe WCD-associated adverse events occurred during the CR stay of a median 28 (28, 28) d. The fabric garment and the device setting needed to be adjusted in two patients to diminish inappropriate automatic alarms. Left ventricular ejection fraction after CR increased significantly to 42 (30, 44)% (P < .001). Wearable cardioverter-defibrillator therapy was stopped due to LVEF restitution in 53% of patients. In 36% of patients an implantable cardioverter-defibrillator was implanted, 6% had LVEF improvement after coronary revascularization, one patient received a heart transplantation (2%), two patients discontinued WCD treatment at their own request (4%). Conclusion: Completing CR is feasible and safe for WCD patients and may contribute positively to the restitution of cardiac function.

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Section: Discussionsupporting

confidence: 51%

Cardiovascular Rehabilitation With a WCD—Data From the CR3 Study (Cardiac Rehab Retrospective Review)

Rohrer,

Reischl,

Manninger

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…There are a large number of studies related to improving CR initiation rates 2,3. However, there are a limited number of studies that have explored factors associated with CR completion and potential solutions to increase completion rates (40-60%) 3–5. These studies have generally lacked patient-level details about the underlying challenges patients face in completing a course of CR.…”

mentioning

confidence: 99%

Cardiac Rehabilitation Completion Study: Barriers and Potential Solutions

Supervía

Medina‐Inojosa

Martı́nez-Jarreta

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

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muscle structure, as well as convective and diffusive oxygen delivery. 10,11 Knee extensor training also conferred improvements in quadriceps muscle strength and health-related QoL. Moreover, the high training compliance suggests that it is a practicable intervention.We identified evidence gaps including the optimal knee extensor training protocol for HF and its efficacy in HFpEF. Future research evaluating this training paradigm requires consistency in methods and measurement of short-and longer-term outcomes including morbidity and mortality. Assessment of practicality within clinical settings and patient tolerance of the training is also essential.In conclusion, these results suggest that isolated knee extensor training in HFrEF improves short-term outcomes including whole-body exercise capacity. This training appears to be feasible and, in our opinion, could be applied to rehabilitation and/or home exercise programs using readily available modalities such as knee extensor machines, ankle weights, and resistance bands. Small muscle mass exercise may therefore have a wide application as an alternative or adjunct training intervention for the broad spectrum of individuals with HF due to the decreased demand on the compromised cardiac system.

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“…Likewise, the patients' age and functional capacity is important to consider in planning the programme to maintain patients' adherence and completion. These clinical experiences are relevant as patient-reported reasons for non-adherence have been stated as; did not need the cardiac rehablitation trajectory, the program was not personal enough, content of CR program was not as expected, and intensity of the CR program was too burdensome [ 41 ]. Low adherence may also be due to comorbidities and patient who “already exercise regularly” [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…These clinical experiences are relevant as patient-reported reasons for non-adherence have been stated as; did not need the cardiac rehablitation trajectory, the program was not personal enough, content of CR program was not as expected, and intensity of the CR program was too burdensome [ 41 ]. Low adherence may also be due to comorbidities and patient who “already exercise regularly” [ 41 ]. Patient-reported information on non-adherence was not available, but it would be relevant to clarify why half or less of the patients in LC and EMMA adhered ≥ 75% of a full programme.…”

Section: Discussionmentioning

confidence: 99%

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

Pedersen

Nielsen

Lynggaard

et al. 2022

BMC Cardiovasc Disord

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Background Adherence 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). Method A 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. Result Patients 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). Conclusion This 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.

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Identifying Reasons for Nonattendance and Noncompletion of Cardiac Rehabilitation

Cited by 7 publications

References 33 publications

Cardiovascular Rehabilitation With a WCD—Data From the CR3 Study (Cardiac Rehab Retrospective Review)

Cardiovascular Rehabilitation With a WCD—Data From the CR3 Study (Cardiac Rehab Retrospective Review)

Cardiac Rehabilitation Completion Study: Barriers and Potential Solutions

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

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