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The impact of drop-out in cardiac rehabilitation on outcome among coronary artery disease patients

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Abstract
Background: The effect of adherence to cardiac rehabilitation (CR) on outcome is not clear. Therefore, we aimed to assess the impact of drop-out for non-medical reasons of CR on event-free survival in coronary artery disease (CAD). Methods: A total of 876 patients who attended CR after acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) were included. Drop-out was defined as attending 50% of the training sessions. A combined endpoint of all-cause mortality and rehospitalization for a cardiovascular event was used to specify event-free survival. Differences in clinical characteristics were assessed and parameters with p<0.10 were entered in a multiple Cox regression analysis. Results: A total of 15% died or had a cardiovascular event during a median follow-up period of 33 months (interquartile range 24, 51). Overall, 17% dropped out before finishing half of the program. Patients who withdrew prematurely had a risk twice as high for a cardiovascular event or death (hazard ratio 1.92, 95% confidence interval 1.28-2.90) than those who attended more than half of the sessions. Both ACS (2.36, 1.47-3.58) and PCI (2.20, 1.22-3.96), as primary indicators for CR, were associated with an adverse outcome and also a prior history of chronic heart failure (CHF) remained negatively associated with event-free survival (3.67, 1.24-10.91).Finally, the presence of hyperlipidemia was independently related to a worse outcome (1.48, 1.02-2.16). Conclusions: Drop-out for non-medical reasons was independently associated with a negative outcome in CAD. Therefore, underlying factors for drop-out should gain more attention in future research and should be taken into account when organizing CR.
Keywords
Coronary artery disease, cardiac rehabilitation, event-free survival, drop-out, OBSTRUCTIVE PULMONARY-DISEASE, HEART-FAILURE PATIENTS, CLINICAL CHARACTERISTICS, METAANALYSIS, COMMUNITY, SURVIVAL, PREDICTORS, COEXISTENT, PROGNOSIS, SURGERY

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Chicago
Pardaens, Sofie, Anne-Marie Willems, Els Clays, Anneleen Baert, Marc Vanderheyden, Sofie Verstreken, Inge Du Bois, Delphine Vervloet, and Johan De Sutter. 2017. “The Impact of Drop-out in Cardiac Rehabilitation on Outcome Among Coronary Artery Disease Patients.” European Journal of Preventive Cardiology 24 (14): 1490–1497.
APA
Pardaens, S., Willems, A.-M., Clays, E., Baert, A., Vanderheyden, M., Verstreken, S., Du Bois, I., et al. (2017). The impact of drop-out in cardiac rehabilitation on outcome among coronary artery disease patients. EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, 24(14), 1490–1497.
Vancouver
1.
Pardaens S, Willems A-M, Clays E, Baert A, Vanderheyden M, Verstreken S, et al. The impact of drop-out in cardiac rehabilitation on outcome among coronary artery disease patients. EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY. 2017;24(14):1490–7.
MLA
Pardaens, Sofie, Anne-Marie Willems, Els Clays, et al. “The Impact of Drop-out in Cardiac Rehabilitation on Outcome Among Coronary Artery Disease Patients.” EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY 24.14 (2017): 1490–1497. Print.
@article{8544032,
  abstract     = {Background: The effect of adherence to cardiac rehabilitation (CR) on outcome is not clear. Therefore, we aimed to assess the impact of drop-out for non-medical reasons of CR on event-free survival in coronary artery disease (CAD). 
Methods: A total of 876 patients who attended CR after acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) were included. Drop-out was defined as attending 50\% of the training sessions. A combined endpoint of all-cause mortality and rehospitalization for a cardiovascular event was used to specify event-free survival. Differences in clinical characteristics were assessed and parameters with p{\textlangle}0.10 were entered in a multiple Cox regression analysis. 
Results: A total of 15\% died or had a cardiovascular event during a median follow-up period of 33 months (interquartile range 24, 51). Overall, 17\% dropped out before finishing half of the program. Patients who withdrew prematurely had a risk twice as high for a cardiovascular event or death (hazard ratio 1.92, 95\% confidence interval 1.28-2.90) than those who attended more than half of the sessions. Both ACS (2.36, 1.47-3.58) and PCI (2.20, 1.22-3.96), as primary indicators for CR, were associated with an adverse outcome and also a prior history of chronic heart failure (CHF) remained negatively associated with event-free survival (3.67, 1.24-10.91).Finally, the presence of hyperlipidemia was independently related to a worse outcome (1.48, 1.02-2.16). 
Conclusions: Drop-out for non-medical reasons was independently associated with a negative outcome in CAD. Therefore, underlying factors for drop-out should gain more attention in future research and should be taken into account when organizing CR.},
  author       = {Pardaens, Sofie and Willems, Anne-Marie and Clays, Els and Baert, Anneleen and Vanderheyden, Marc and Verstreken, Sofie and Du Bois, Inge and Vervloet, Delphine and De Sutter, Johan},
  issn         = {2047-4873},
  journal      = {EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY},
  keyword      = {Coronary artery disease,cardiac rehabilitation,event-free survival,drop-out,OBSTRUCTIVE PULMONARY-DISEASE,HEART-FAILURE PATIENTS,CLINICAL CHARACTERISTICS,METAANALYSIS,COMMUNITY,SURVIVAL,PREDICTORS,COEXISTENT,PROGNOSIS,SURGERY},
  language     = {eng},
  number       = {14},
  pages        = {1490--1497},
  title        = {The impact of drop-out in cardiac rehabilitation on outcome among coronary artery disease patients},
  url          = {http://dx.doi.org/10.1177/2047487317724574},
  volume       = {24},
  year         = {2017},
}

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