P2495Cardiac rehabilitation: don't forget the ones that went away

Abstract

Introduction: Cardiac rehabilitation program (CRP) is an intervention designed to promote a healthy lifestyle. In spite of a strong commitment from health-professionals, a significant number of patients (pts) leave the program. Our goal was to evaluate the socio-demographic and clinical features of pts not completing the CRP. Methods: We analysed data from a prospective registry of 840 consecutive pts enrolled in a CRP after an acute coronary syndrome (ACS), between 2008 and 2016. Forty-two pts were excluded from the CRP due to medical reasons. Results: From the total of 798 patients, 86% male and mean age 54.5±9.9 years old. Most pts were actively working (55,4%) and married (92,8%). The prevalence of the classic cardiovascular risk factors was high with 59.9% dyslipidemic; 55.8% active smokers; 42.6% hypertensive; 24.9% obese and 18.5% diabetic. The dropout rate from CRP was 7,9% (63 pts). Main reasons for dropping out were lack of economic means or transportation constraints (23.8%), need to return to work (7.1%) and available exercise sessions schedules (2.9%). Women were slightly more prone to leave CRP (p=0.05). Pts leaving the CRP were younger (51.2±9.1 vs 54.3±9.8 years old, p=0.011), more often lived alone (38.1% vs 17.1%, p<0.001) and were unemployed/retired (55.6% vs 41.8%, p=0.046). Prevalence of active smokers (73.0% vs 54.3%, p=0.005) and obese (42.9% vs 22.7%, p=0.001) was also higher among these pts. Although there was no difference in functional capacity in baseline exercise testing (METs 8.9±2.3 vs 8.4±2.6, p=0.084), at 1-year follow-up, those completing CRP showed better performance (METs 10.7±2.3 vs 9.0±2.2, p<0.001). Independent predictors of non-completion of CRP by multivariate logistic regression modelling were obesity (OR 2.7, 95% CI 1.6-4.6, p<0.001), smoking (OR 2.4, 95% CI 1.3-4.3, p=0.004), unemployment (OR 1.9, 95% CI 1.1-3.2, p=0.017) and living alone (OR 2.9, 95% CI 1.6-5.0, p<0.001). Conclusion: The benefits of CRP enrollment after an ACS are undeniable. However, dropout rates remain high and are a source of concern in CRP. Identifying those at higher risk of non-compliance, especially those with social and economic disadvantages might steer a redesign of CRP programs, and alternatives to reduce costs and inequities in access to this cost-effective treatment option.