Abstract 17051: Cardiac Rehabilitation: Characteristics of Those Who Drop Out After Initiating a Program
Background: Cardiac Rehabilitation (CR) is an efficacious, evidence based treatment for reducing mortality and hospitalization in subjects with coronary artery disease (CAD). Many appropriate patients are not referred for CR, and even among those referred there is a considerable dropout rate. The objective of this study was to assess what factors predict non-completion of CR among those that begin a program.
Methods: All subjects who were referred to and began a multidisciplinary 12-week CR program for CAD in Calgary, Canada between 1996 and 2012 were included in the study (n=10,483, 19.1% female). Subjects were considered to have completed CR if they attended both baseline and 12-week assessments, as well as at least half of their exercise sessions. Baseline characteristics were compared between those who completed the program and did not. Logistic regression models predicting completion were developed, adjusted for all available clinical and demographic characteristics.
Results: Of those subjects who began CR, 8,650 (82.5%) completed the program. Relative to those who did not completer CR, those who completed were more likely to be male (82.1 vs. 75.3%, p<0.0001), were older (mean age 59.7 vs. 58.2 years, p<0.0001), and less likely to be diabetic (17.2 vs 23.1%, p<0.0001). At baseline assessment, non-completers were more likely to be smokers (34.9 vs. 16.7%, p<0.0001), were heavier (BMI 29.1 vs. 28.1 kg/m2, p<0.0001), achieved lower metabolic equivalents (METs) on treadmill testing (6.9 vs. 7.8 METs, p<0.0001) and had higher fasting LDL cholesterol and glucose (2.3 vs. 2.1 mmol/L and 6.3 vs. 5.9 mmol/L, respectively; both p<0.0001). In adjusted models baseline METs (OR 1.26 per MET, 95% CI 1.18, 1.34) predicted completion, while ongoing smoking (OR 0.55, 95% CI 0.40, 0.75) and elevated fasting glucose (OR 0.88, 95% CI 0.83, 0.93) and LDL cholesterol (OR 0.87, 95% CI 0.77, 0.99) predicted non-completion.
Conclusion: While CR completion rates are high among those that start the program, there remains a significant drop out rate. Importantly, those with higher baseline risk - lower fitness, ongoing smoking, poorly controlled lipids and glucose - are more likely to drop out. Interventions to encourage completion in these high risk populations need to be considered
- © 2013 by American Heart Association, Inc.