Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an explorator
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Neth Heart J https://doi.org/10.1007/s12471-020-01492-0
Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study R. W. M. Brouwers · V. J. G. Houben · J. J. Kraal · R. F. Spee · H. M. C. Kemps
Accepted: 8 September 2020 © The Author(s) 2020
Abstract Background Despite proven clinical benefits, only a minority of patients complete outpatient cardiac rehabilitation (CR) after acute myocardial infarction (AMI). The main purpose of this study was to evaluate to what extent and at which time patients drop out of CR, and to assess which patient-related characteristics can predict dropout. Methods In a retrospective cohort study, we selected patients who had been hospitalised with an AMI in our centre in 2015 or 2016. Patients were selected pseudonymously based on reimbursement codes in the electronic health record. We extracted baseline characteristics and data on CR referral, enrolment and completion for each patient. Multivariable logistic regression was used to assess which characteristics predicted referral and dropout. Results The 666 patients included were predominantly male (66%), with a mean age of 69.0 years. Of the 640 eligible patients, 201 (31%) were not referred for CR. Enrolment after referral was 94%. Nonreferral was independently associated with older age, female sex, traveling distance, non-ST-elevation myocardial infarction (NSTEMI; as compared with STEMI), no coronary revascularisation and prior manifestations of coronary artery disease. Of the 414 enrolled patients, 24% did not complete their CR programmes (i.e. dropped out). Older age and worse exercise capacity at baseline were independently associated with dropout. The ability of the multiple regression models to predict nonreferral and noncompletion was good to R. W. M. Brouwers () · V. J. G. Houben · J. J. Kraal · R. F. Spee · H. M. C. Kemps Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands [email protected]
fair, with an area under the receiver operating characteristic curves of 0.86 and 0.71, respectively. Conclusion The main reason for not participating in or not completing CR after AMI was nonreferral. To optimise CR utilisation, improvement of referral rates should be prioritised. Keywords Cardiac rehabilitation · Acute myocardial infarction · Referral · Enrolment · Participation · Completion
Introduction Cardiac rehabilitation (CR) reduces cardiovascular morbidity and mortality and increases quality of life in patients after acute myocardial infarction (AMI) [1–3]. Therefore, CR is strongly recommended in American and European guidelines [4–7]. Still, less
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The main reason for not participating in or not completing cardiac rehabilitation (CR) after acute myocardial infarction was nonreferral. Although dropout after referral was lower, more than half of discharged patients ultimately did not complete a CR programme. To optimise CR utilisation, improveme
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