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The Heterogeneous Trajectory of Adherence to Home-Based Cardiac Rehabilitation Exercises in Patients With Coronary
Lushuang Yuan1, Linyu Xu2, Chunqi Zhang1
1The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China.
Insights
This study identified distinct exercise adherence patterns in cardiac rehabilitation patients over 12 months. Heterogeneous trajectories, like gradual decline and non-adherence, predict higher readmission risks, necessitating tailored interventions for coronary heart disease management.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Health Psychology
Background:
- Home-based cardiac rehabilitation is crucial for coronary heart disease (CHD) patients.
- Understanding long-term exercise adherence is vital for treatment effectiveness.
- Patient engagement in rehabilitation programs can be dynamic and varied.
Purpose of the Study:
- To investigate the 12-month trajectory of home-based exercise adherence in CHD patients.
- To identify distinct adherence patterns (trajectories) and their predictors.
- To explore the link between adherence trajectories and cardiovascular readmissions.
Main Methods:
- Prospective cohort study involving 428 CHD patients.
- Latent Class Growth Model used to define adherence trajectories.
- Cox proportional hazards and multivariable logistic regression models for predictor identification.
Main Results:
- Five distinct exercise adherence trajectories were identified: persistent adherence, gradual decline, U-shaped adherence, delayed initiation, and consistent non-adherence.
- A heterogeneous adherence trajectory (gradual decline and consistent non-adherence) was associated with increased cardiovascular readmissions.
- Seven independent predictors for heterogeneous adherence were found, including education, ejection fraction, C-reactive protein, frailty, depression, motivation, and work conditions.
Conclusions:
- Distinct adherence trajectories highlight the dynamic nature of cardiac rehabilitation engagement.
- Heterogeneous adherence patterns are linked to higher readmission risks, indicating a need for targeted interventions.
- Personalized rehabilitation strategies based on identified predictors can improve adherence and reduce healthcare burdens.
Aims:
The aim of this study was to explore the trajectory of home-based cardiac rehabilitation exercise adherence in patients with coronary heart disease over 12 months and to identify heterogeneous trajectories and their predictors.
Design:
A prospective cohort study with 428 coronary heart disease patients was conducted in this study.
Methods:
The Latent Class Growth Model was adopted to describe exercise adherence trajectories, and heterogeneous adherence trajectory was determined based on the Cox proportional hazards regression model. Predictors were identified using a multivariable logistic regression model. The study was conducted from January 2023 to April 2024.
Results:
This study explored five adherence trajectories, including persistent adherence, gradual decline, U-shaped adherence, delayed initiation and consistent non-adherence. Two of these trajectories (gradual decline and consistent non-adherence) were merged and labelled as a heterogeneous adherence trajectory based on association with cardiovascular readmissions. Regression analysis revealed seven independent predictors for the heterogeneous trajectory, covering education level, ejection fraction, C-reactive protein level, frailty, depression, exercise motivation and work conditions.
Conclusions:
The identification of distinct adherence trajectories and their predictors highlights the dynamic nature of cardiac rehabilitation engagement. Heterogeneous trajectories (gradual decline and non-adherence) were strongly linked to increased readmission risks, emphasising the need for targeted interventions in high-risk subgroups.
Impact:
These findings provide a framework for nurses to stratify patients' adherence risks early and personalise rehabilitation strategies. Addressing modifiable predictors (e.g., depression management, frailty mitigation and motivation enhancement) could improve long-term adherence, reduce healthcare burdens from readmissions and optimise resource allocation in cardiac rehabilitation programmes.
Reporting Method:
The reporting procedure of this study followed the STROBE guidelines.
Patient Or Public Contribution:
No patient or public contribution.
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