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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Predictors of Cardiac Rehabilitation Initiation and Adherence in a Multiracial Urban Population
Lili Zhang1, Maria Sobolev, Ileana L Piña
1Montefiore Medical Center, Bronx, New York.
Insights
Cardiac rehabilitation (CR) initiation and adherence are low, especially for nonwhite patients and those lacking insurance. Copayments and younger age predict poor adherence, highlighting the need for improved access and affordability.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiac rehabilitation (CR) initiation and adherence remain significant challenges.
- A unique, minority-predominant urban population was studied to identify predictors.
- Understanding these predictors is crucial for improving CR participation.
Purpose of the Study:
- To examine predictors of initiation, adherence, and completion of outpatient cardiac rehabilitation.
- To analyze factors influencing CR engagement in a diverse urban patient cohort.
- To inform strategies for enhancing CR program accessibility and effectiveness.
Main Methods:
- Retrospective analysis of 590 patients referred to outpatient CR from 1997-2010.
- Defined adherence as >=18 sessions and completion as >=36 sessions.
- Multivariable logistic regression used to identify predictors of CR initiation, adherence, and completion.
Main Results:
- Nonwhite patients (OR=0.66) and uninsured patients (OR=0.54) were less likely to initiate CR.
- Older age (OR=1.04) predicted better adherence, while copayment requirement (OR=0.57) predicted poorer adherence.
- Of 400 patients initiating CR, 57.3% adhered and 35.0% completed.
Conclusions:
- Nonwhite race and lack of insurance are barriers to CR initiation.
- Copayments and younger age are associated with reduced CR adherence.
- Expanding insurance coverage and eliminating copayments may improve CR participation and adherence.
Background:
Lack of initiation and adherence to cardiac rehabilitation (CR) remains a persistent problem. We sought to examine predictors of initiation, adherence, and completion of CR in a unique, minority predominant, urban population.
Methods:
We included all patients who were first-time referred to the outpatient CR program at Montefiore Medical Center between 1997 and 2010. The indications for referral included acute myocardial infarction, coronary artery disease, heart failure, stable angina, and valvular heart disease. Adherence was defined as attendance of at least 18 sessions of CR, and completion was defined as attendance of 36 sessions. Multivariable logistic regression was utilized to examine the predictors of initiation, adherence, and completion of CR.
Results:
A total of 590 patients were included (43.9% white and 56.1% nonwhite patients). Among 400 patients who initiated CR, 229 patients (57.3%) attended at least 18 sessions and 140 patients (35.0%) completed all sessions. Initiation of CR was less likely in patients who were nonwhite (OR = 0.66; 95% CI: 0.44-0.97; P = .04) and those who lacked insurance (OR = 0.54; 95% CI: 0.29-0.83; P = .04). Older age was associated with better adherence (OR = 1.04; 95% CI: 1.02-1.07; P < .001). Requirement of a copayment (OR = 0.57; 95% CI: 0.37-0.87; P = .01) was associated with poor adherence.
Conclusion:
In a multiracial population, nonwhite patients and those who did not have insurance were less likely to initiate CR. Younger age and requirement of copayment were independent predictors for poor adherence. Increasing medical insurance coverage and eliminating copayment may improve the participation and adherence of CR.
