Abstract Submitter: Associate Professor Benzer Werner
Event: EuroPRevent 2012
Title: Predictors of drop-out from cardiac rehabilitation programs in Europe
Evaluation Topic: 02.08 - Atherosclerosis/CAD (Rehabilitation & Implementation)
Acronym Abbreviation: EuroCaReD
Acronym: European Cardiac Rehabilitation Database
Category: Member of EACPR
Options: No Options
W. Benzer1, B. Rauch2, E. Koudi3, AD. Zwisler4, NE. Pogosova5, P. Dendale6, JP. Schmid7, C. Davos8, EG. Porrero9, H. Mc Gee10 - (1) Department of Interventional Cardiology, Academic Hospital, Feldkirch, Austria (2) Center for Outpatient Rehabilitation at the Hospital, Ludwigshafen, Germany (3) Aristotle University of Thessaloniki, Laboratory of Sports Medicine, Thessaloniki, Greece (4) Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark (5) National Research Center for Preventive Medicine, Moscow, Russian Federation (6) Heart Centre, University, Hasselt, Belgium (7) Bern University Hospital, Cardiovascular Prevention and Rehabilitation, Bern, Switzerland (8) Biomedical Research Foundation, Academy of Athens, Athens, Greece (9) Cardiac Rehabilitation Centre, City Hospital, Leon, Spain (10) Royal College of Surgeons in Ireland, Dublin, Ireland
Abstract Content 90%
Background: Substantial numbers of patients participating in cardiac rehabilitation (CR) do not complete their programs prescribed because of early discontinuation.
The purpose of this study was to assess reasons and predictors of drop-out from different CR programs focused on European countries. Methods: European Cardiac Rehabilitation Database (EuroCaReD) was introduced to get information on service provision and outcomes in CR across Europe. In 8 European countries 1.236 patients participating in a CR program could be enrolled into the database in October and November 2010. Datasets of 360 patients (mean age 64 years; 26% female) did include drop-out numbers and reasons and were suitable to be included into the study. P- values and Odds ratios (95% CI)were calculated to assess the strength of the differences between patients who completed their prescribed CR program and those who dropped out. Results: 273 patients (76%) of 360 completed their CR program whereas 87 patients (24%) did not. The main reason of drop-out was patient non-compliance (26.4%), recurrent event within the CR program timeframe (5.6%) and others not specified (64.4%). Recurrent events were most frequently the need of PCI (22%) followed by death from non-cardiovascular disease (11%). Relevant comorbidities could be detected as predictors of drop-out from CR programs (renal failure: p<0.05, OR 0.24 (0.06-0.9); history of stroke: p<0.05, OR 0.29 (0.09-0.90)). Higher body weight (p<0.05), higher blood pressure (p<0.01) and lower METs achieved at program start (p<0.05) were predictors of early drop-out from a CR program. Age, gender, and initiating event did not influence the drop-out rate. Conclusions: In European countries ¼ of patients referred for CR did not complete their programs as prescribed. This result identifies the need for measures to reduce drop-out rates in CR. Patients who have to interrupt their program because of interventions most frequently PCI should be readmitted as soon as possible. Because of the drop-out risk in patients with special comorbidities, particularly renal failure and history of stroke and in patients with higher cardiovascular risk burden and lower exercise capacity, these subgroups should receive special attention. The high percentage of patients with unspecified reasons of CR program interruption needs further investigation.