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Determinants of risk factor target attainment after myocardial infarction: the Perfect-CR study

Halldora Ögmundsdottir Michelsen1,2, Peter Henriksson3, John Wallert4

  • 1Department of Geriatric Medicine, Landspitali University Hospital, 105 Reykjavik, Iceland.

European Journal of Cardiovascular Nursing
|July 8, 2026
PubMed

Insights

Cardiac rehabilitation programs with strong organizational support, including psychosocial care and nurse protocols, improve risk factor control after myocardial infarction (MI). Patient participation in exercise also enhances outcomes.

Area of Science:

  • Cardiology
  • Public Health
  • Healthcare Management

Background:

  • Cardiac rehabilitation (CR) is crucial for post-myocardial infarction (MI) recovery.
  • Understanding which CR components predict risk factor target attainment is vital for optimizing patient outcomes.
  • Predictive strength of organizational versus patient factors needs clarification.

Purpose of the Study:

  • To identify organizational and patient-level predictors of risk factor target attainment 1-year post-MI.
  • To assess the relative predictive power of CR program components versus patient characteristics.

Main Methods:

  • Surveyed organizational structure and processes of 78 Swedish CR centers.
  • Merged CR data with patient registry data (n=6755).
  • Used orthogonal partial least squares discriminant analysis to identify predictors (VIP > 0.8) of LDL-C, BP targets, and smoking abstinence.

Main Results:

  • Organizational predictors for LDL-C/BP targets: psychosocial management, nurse protocols, nurse continuity, extended hours, facilities, medical director.
  • Patient predictors for LDL-C/BP targets: low baseline LDL-C, no hypertension history, exercise-based CR participation.
  • Organizational predictors for smoking abstinence: psychosocial management, medical director, NRT/varenicline prescribing, team spirit.
  • Patient predictors for smoking abstinence: exercise-based CR, group education.

Conclusions:

  • Multiple CR organizational factors significantly predict attainment of key risk factor targets post-MI.
  • Findings can inform the design of more effective, comprehensive CR programs.
  • Optimizing CR program structure enhances patient risk factor management.
Abstract

Keywords:
Cardiac rehabilitationMyocardial infarctionRisk factorsSecondary prevention

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