Participating or not in a cardiac rehabilitation programme: factors influencing a patient’s decision

Abstract

Background: International research indicates that attendance of patients to a proposed cardiac rehabilitation (CR) programme varies between 21% and 75%. Addressing the reasons why cardiac patients are not participating will improve accessibility to CR. The objective of this study was to investigate patient compliance with cardiac rehabilitation and the reasons of refusing or abandoning the programme.

Methods: Twenty hospital centres were recruited to participate. Each centre was asked to recruit patients from three patient groups, namely: percutaneous coronary intervention patients, patients that underwent major cardiac surgery, and patients being admitted because of an acute myocardial infarction and not belonging to the other two groups. Patients were asked to fill out a questionnaire during a follow-up outpatient consultation after the cardiac intervention.

Results: In total, 226 patients participated in the survey. Most patients were proposed (86%) and accepted (81% out of proposed) to attend a CR programme. Of those who accepted, 77% completed the programme. The main reasons that led to patients’ refusal to participate in a CR programme were distance to the CR centre, patients’ belief they could handle their own problems, and lack of time. The main three reasons for not completing an initiated CR programme were other physical problems, patients’ belief they could handle their own problems, and the cost of rehabilitation.

Conclusion: Our findings demonstrate the importance of raising patients’ awareness of the benefits of CR. Addressing potential barriers to attend a CR programme should be investigated with patients individually in order to ensure compliance.

Keywords

Cardiac rehabilitation compliance participation persistence

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References

Davies

Moxham

Rees

. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 2010; 4: CD003331–CD003331.

Taylor

Brown

Ebrahim

. Exercise-based rehabilitation for patients with coronary heart disease: Systematic review and meta-analysis of randomized controlled trials. Am J Med 2004; 116(10): 682–692.

Taylor

Unal

Critchley

. Mortality reductions in patients receiving exercise-based cardiac rehabilitation: How much can be attributed to cardiovascular risk factor improvements? Eur J Cardiovasc Prev Rehabil 2006; 13(3): 369–374.

National Institute for Health and Clinical Excellence. Cardiac rehabilitation service: commissioning guide. London: NICE, March 2008.

Piepoli

Corra

Benzer

. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. Eur J Cardiovasc Prev Rehabil 2010; 17(1): 1–17.

Vanhees

McGee

Dugmore

. A representative study of cardiac rehabilitation activities in European Union Member States: the Carinex survey. J Cardiopulm Rehabil 2002; 22(4): 264–272.

Belgian Ministry working Group. Cardiac Rehabilitation, Report, RIZIV, Belgium, February 2007.

Bjarnason-Wehrens

McGee

Zwisler

. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil 2010; 17(4): 410–418.

Bethell

Lewin

Dalal

. Cardiac rehabilitation in the United Kingdom. Heart 2009; 95(4): 271–175.

10.

Campbell

Grimshaw

Rawles

. Cardiac rehabilitation in Scotland: is current provision satisfactory? J Public Health Med 1996; 18(4): 478–480.

11.

Daly

Sindone

Thompson

. Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review. Prog Cardiovasc Nurs 2002; 17(1): 8–17.

12.

De Angelis

Bunker

Schoo

. Exploring the barriers and enablers to attendance at rural cardiac rehabilitation programs. Aust J Rural Health 2008; 16(3): 137–142.

13.

Grace

Evindar

Abramson

. Physician management preferences for cardiac patients: factors affecting referral to cardiac rehabilitation. Can J Cardiol 2004; 20(11): 1101–1107.

14.

Grace

Krepostman

Brooks

. Referral to and discharge from cardiac rehabilitation: key informant views on continuity of care. J Eval Clin Pract 2006; 12(2): 155–163.

15.

Grace

Gravely-Witte

Brual

. Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study. Eur J Cardiovasc Prev Rehabil 2008; 15(5): 548–556.

16.

Jackson

Leclerc

Erskine

. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart 2005; 91(1): 10–14.

17.

Tolmie

Lindsay

Kelly

. Are older patients’ cardiac rehabilitation needs being met? J Clin Nurs 2009; 18(13): 1878–1888.

18.

Witt

Thomas

Roger

. Cardiac rehabilitation after myocardial infarction: a review to understand barriers to participation and potential solutions. Eura Medicophys 2005; 41(1): 27–34.

19.

Worcester

Murphy

Mee

. Cardiac rehabilitation programmes: predictors of non-attendance and drop-out. Eur J Cardiovasc Prev Rehabil 2004; 11(4): 328–335.

20.

Thompson

Clark

. Cardiac rehabilitation: into the future. Heart 2009; 95(23): 1897–1900.

21.

Brown

Hernandez

Bittner

. Predictors of cardiac rehabilitation referral in coronary artery disease patients: findings from the American Heart Association’s Get With The Guidelines Program. J Am Coll Cardiol 2009; 54(6): 515–521.

22.

Higgins

Murphy

Goble

. Cardiac rehabilitation program attendance after coronary artery bypass surgery: overcoming the barriers. Med J Aust 2008; 188(12): 712–714.

23.

Wenger

. Current status of cardiac rehabilitation. J Am Coll Cardiol 2008; 51(17): 1619–1631.

24.

Grace

Gravely-Witte

Kayaniyil

. A multisite examination of sex differences in cardiac rehabilitation barriers by participation status. J Womens Health (Larchmt) 2009; 18(2): 209–216.

25.

Marzolini

Brooks

. Sex differences in completion of a 12-month cardiac rehabilitation programme: an analysis of 5922 women and men. Eur J Cardiovasc Prev Rehabil 2008; 15(6): 698–703.

26.

Molloy

Hamer

Randall

. Marital status and cardiac rehabilitation attendance: a meta-analysis. Eur J Cardiovasc Prev Rehabil 2008; 15(5): 557–561.

27.

Redfern

Ellis

Briffa

. High risk-factor level and low risk-factor knowledge in patients not accessing cardiac rehabilitation after acute coronary syndrome. Med J Aust 2007; 186(1): 21–25.

28.

French

Cooper

Weinman

. Illness perceptions predict attendance at cardiac rehabilitation following acute myocardial infarction: a systematic review with meta-analysis. J Psychosom Res 2006; 61(6): 757–767.

29.

Fernandez

Salamonson

Juergens

. Development and preliminary testing of the Cardiac Rehabilitation Enrolment Obstacles (CREO) scale: implications for service development. Eur J Cardiovasc Nurs 2008; 7(2): 96–102.

30.

Beswick

Rees

Griebsch

. Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups. Health Technol Assess 2004; 8(41): iii–x, 1.

31.

Thompson

. Improving cardiac rehabilitation: a view from the United Kingdom. Eur J Cardiovasc Nurs 2002; 1(2): 95–9.

32.

Zutz

Ignaszewski

Bates

. Utilization of the internet to deliver cardiac rehabilitation at a distance: a pilot study. Telemed J E Health 2007; 13(3): 323–330.

33.

World Health Organization. Cardiac rehabilitation and secondary prevention: long term care for patients with ischaemic heart disease. Briefing letter, regional office for Europe. Copenhagen, Denmark: WHO, 1993.

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