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Comorbidities and psychosocial characteristics as determinants of dropout in outpatient cardiac rehabilitation

Sofie Pardaens UGent, Delphine De Smedt UGent, Dirk De Bacquer UGent, Anne-Marie Willems, Sofie Verstreken and Johan De Sutter UGent (2017) JOURNAL OF CARDIOVASCULAR NURSING. 32(1). p.14-21
abstract
Background: Despite the clear benefits of cardiac rehabilitation (CR), a considerable number of patients drop out early. Objective: Therefore, we wanted to evaluate dropout in CR with a special focus on comorbidities and psychosocial background. Methods: Patients who attended CR after acute coronary syndrome, cardiac surgery, or heart failure (N = 489) were prospectively included. Dropout was defined as attending 50% of the training sessions or less (n = 96 [20%]). Demographic and clinical characteristics, exercise parameters, and psychosocial factors were analyzed according to dropout, and those with a trend toward a significant difference (P G .10) were entered in a multivariate logistic model. Results: The presence of a cerebrovascular accident (4.18 [1.39Y12.52]) involved a higher risk of dropout, and a comparable trend was seen for the presence of chronic obstructive pulmonary disease (2.55 [0.99Y6.54]). Attending the training program only twice per week also implicated a higher risk of an early withdrawal (3.76 [2.23Y6.35]). In contrast, patients on "-blockers were less likely to withdraw prematurely (0.47 [0.22Y0.98]). Singles were more likely to drop out (2.89 [1.56Y5.35]), as well as those patients who were dependent on others to get to CR (2.01 [1.16Y3.47]). Finally, the reporting of severe problems on the anxiety/depression subscale of the EuroQOL-5D questionnaire involved a higher odds for dropout (7.17 [1.46Y35.29]). Conclusions: Neither demographic characteristics nor clinical status or exercise capacity could independently identify patients who were at risk of dropout. The presence of comorbidities and a vulnerable psychosocial background rather seem to play a key role in dropout.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
psychosocial characteristics, exercise capacity, dropout, comorbidities, cardiac rehabilitation, OBSTRUCTIVE PULMONARY-DISEASE, QUALITY-OF-LIFE, CORONARY-HEART-DISEASE, ACUTE MYOCARDIAL-INFARCTION, FAILURE PATIENTS, EUROASPIRE III, HEALTH-STATUS, MORTALITY, PREDICTORS, COEXISTENT
journal title
JOURNAL OF CARDIOVASCULAR NURSING
J. Cardiovasc. Nurs.
volume
32
issue
1
pages
14 - 21
Web of Science type
Article
Web of Science id
000390446200005
ISSN
0889-4655
DOI
10.1097/JCN.0000000000000296
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
7063330
handle
http://hdl.handle.net/1854/LU-7063330
date created
2016-01-29 15:47:09
date last changed
2017-06-27 10:45:49
@article{7063330,
  abstract     = {Background: Despite the clear benefits of cardiac rehabilitation (CR), a considerable number of patients drop out early.
Objective: Therefore, we wanted to evaluate dropout in CR with a special focus on comorbidities and psychosocial background. 
Methods: Patients who attended CR after acute coronary syndrome, cardiac surgery, or heart failure (N = 489) were prospectively included. Dropout was defined as attending 50\% of the training sessions or less (n = 96 [20\%]). Demographic and clinical characteristics, exercise parameters, and psychosocial factors were analyzed according to dropout, and those with a trend toward a significant difference (P G .10) were entered in a multivariate logistic model.
Results: The presence of a cerebrovascular accident (4.18 [1.39Y12.52]) involved a higher risk of dropout, and a comparable trend was seen for the presence of chronic obstructive pulmonary disease (2.55 [0.99Y6.54]). Attending the training program only twice per week also implicated a higher risk of an early withdrawal (3.76 [2.23Y6.35]). In contrast, patients on {\textacutedbl}-blockers were less likely to withdraw prematurely (0.47 [0.22Y0.98]). Singles were more likely to drop out (2.89 [1.56Y5.35]), as well as those patients who were dependent on others to get to CR (2.01 [1.16Y3.47]). Finally, the reporting of severe problems on the anxiety/depression subscale of the EuroQOL-5D questionnaire involved a higher odds for dropout (7.17 [1.46Y35.29]). 
Conclusions: Neither demographic characteristics nor clinical status or exercise capacity could independently identify patients who were at risk of dropout. The presence of comorbidities and a vulnerable psychosocial background rather seem to play a key role in dropout.},
  author       = {Pardaens, Sofie and De Smedt, Delphine and De Bacquer, Dirk and Willems, Anne-Marie and Verstreken, Sofie and De Sutter, Johan},
  issn         = {0889-4655},
  journal      = {JOURNAL OF CARDIOVASCULAR NURSING},
  keyword      = {psychosocial characteristics,exercise capacity,dropout,comorbidities,cardiac rehabilitation,OBSTRUCTIVE PULMONARY-DISEASE,QUALITY-OF-LIFE,CORONARY-HEART-DISEASE,ACUTE MYOCARDIAL-INFARCTION,FAILURE PATIENTS,EUROASPIRE III,HEALTH-STATUS,MORTALITY,PREDICTORS,COEXISTENT},
  language     = {eng},
  number       = {1},
  pages        = {14--21},
  title        = {Comorbidities and psychosocial characteristics as determinants of dropout in outpatient cardiac rehabilitation},
  url          = {http://dx.doi.org/10.1097/JCN.0000000000000296},
  volume       = {32},
  year         = {2017},
}

Chicago
Pardaens, Sofie, Delphine De Smedt, Dirk De Bacquer, Anne-Marie Willems, Sofie Verstreken, and Johan De Sutter. 2017. “Comorbidities and Psychosocial Characteristics as Determinants of Dropout in Outpatient Cardiac Rehabilitation.” Journal of Cardiovascular Nursing 32 (1): 14–21.
APA
Pardaens, S., De Smedt, D., De Bacquer, D., Willems, A.-M., Verstreken, S., & De Sutter, J. (2017). Comorbidities and psychosocial characteristics as determinants of dropout in outpatient cardiac rehabilitation. JOURNAL OF CARDIOVASCULAR NURSING, 32(1), 14–21.
Vancouver
1.
Pardaens S, De Smedt D, De Bacquer D, Willems A-M, Verstreken S, De Sutter J. Comorbidities and psychosocial characteristics as determinants of dropout in outpatient cardiac rehabilitation. JOURNAL OF CARDIOVASCULAR NURSING. 2017;32(1):14–21.
MLA
Pardaens, Sofie, Delphine De Smedt, Dirk De Bacquer, et al. “Comorbidities and Psychosocial Characteristics as Determinants of Dropout in Outpatient Cardiac Rehabilitation.” JOURNAL OF CARDIOVASCULAR NURSING 32.1 (2017): 14–21. Print.