Sociodemographic Predictors in Failure to Complete Outpatient Cardiac Rehabilitation

OBJECTIVE: To investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR). METHODS: This was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis. RESULTS: Only 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001). CONCLUSION: Paying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation.

Which Factors Unexpectedly Increase Depressive Symptom Severity in Patients at the End of a Cardiac Rehabilitation Program?

OBJECTIVE: To investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program. METHODS: The design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis. RESULTS: The results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance. CONCLUSION: The results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables.

[Changes in exercise capacity and modifiable risk factors after a comprehensive cardiac rehabilitation in patients with and without left ventricular systolic dysfunction]

Although the positive effects of cardiac rehabilitation [CR] for patients with heart failure have been known, only a small proportion of such patients have been referred for comprehensive CR. The aim of this study is to compare the extent to which a CR program improved the exercise capacity and modifiable risk factors of patients with and without impaired systolic function. This study was an observational study undertaken in Imam Ali Hospital in Kermanshah [2001 - 2006], the only referral center for CR in the west of Iran. 503 patients, who completed CR program, were included in this study. They were divided into two groups: impaired systolic function with ejection fractions [EF] < 50% [n=185] and normal systolic function [EF >/= 50%, n=317]. Both groups were comparable in terms of all baseline characteristics such as BMI, hypertension, smoking and diabetes. There were significant improvements in exercise capacity, BMI, waist circumference, total cholesterol, LDL, triglyceride, systolic and diastolic blood pressure and depression score in both groups after CR [P<0.001]. However, the effect of CR on HDL did not reach a statistical significant level in either group. In addition further analyses showed that there was no statistically significant differences between patients with severe impaired systolic function [EF < 35%] and normal EF, however changes in lipid profiles were not statistically significant. This study confirmed that the effects of CR on improvement of exercise capacity and risk profiles are almost equal in patients with and without systolic dysfunction