Patient Adherence to a Cardiovascular Rehabilitation Program: What Factors Are Involved?

María José  Bustamante; Giovanna  Valentino; Verónica  Krämer; Marcela  Adasme; Dominique  Guidi; Camila  Ibara; Cinthia  Casasbellas; Lorena  Orellana; Marcelo  Fernández; Mónica  Acevedo; Carlos  Navarrete

doi:10.4236/ijcm.2015.69081

María José Bustamante¹, Giovanna Valentino¹, Verónica Krämer¹, Marcela Adasme¹, Dominique Guidi¹, Camila Ibara¹, Cinthia Casasbellas¹, Lorena Orellana¹, Marcelo Fernández¹, Carlos Navarrete², Mónica Acevedo¹^*

Abstract: Background: Phase II cardiac rehabilitation (CR) is a class IA indication in patients suffering a cardiovascular event (CV). Current guidelines suggest 36 exercise sessions over a period of 3 months. The main aim of this study was to analyze the rate of adherence to a cardiac rehabilitation program and the factors influencing it. Methods: This was a cross-sectional study in 421 secondary prevention patients, who assisted to a Phase-II-CR program between 2007 and 2014. At baseline and program end, patients completed a 6-minute walk test and the Short-Form 36 Health Survey (SF-36). Vital signs and anthropometric measurements were also collected. Adherence was quantified as the percentage of individuals who attended all 36 sessions of the program. Factors considered for affecting adherence included: cardiovascular risk factors (RFs), type of health insurance (public or private), aerobic capacity, and SF-36 score parameters. Results: Adherence to Phase-II-CR was 33%, with no significant differences between men and women. The regression model fully adjusted for age, sex, RFs, type of health insurance and SF-36 score, showed that a SF-36 score <50 on physical health (odds ratio (OR): 11.47; 3.99 - 32.99; p < 0.0001) and smoking (OR: 4.41; 1.25 - 15.62; p = 0.02) were strong predictors for non-adherence. A trend for better adherence was observed in subjects older than 50 years compared to those aged between 17 and 50 years (37% versus 23%, respectively; p = 0.05). No significant differences were observed in adherence according to RFs clustering. Conclusions: Adherence to Phase-II-CR is low in our population. Patient-related factors, such as SF-36 score and smoking, were the best determinants of Phase-II-CR adherence. Health system-related factors did not influence adherence in this population. Prospective studies are warranted to determine all the factors which may influence adherence to Phase-II-CR programs.

Keywords: Cardiac Rehabilitation, Adherence, Secondary Prevention

Cite this paper: Bustamante, M. , Valentino, G. , Krämer, V. , Adasme, M. , Guidi, D. , Ibara, C. , Casasbellas, C. , Orellana, L. , Fernández, M. , Navarrete, C. and Acevedo, M. (2015) Patient Adherence to a Cardiovascular Rehabilitation Program: What Factors Are Involved?. International Journal of Clinical Medicine, 6, 605-614. doi: 10.4236/ijcm.2015.69081.

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