ABSTRACT
Background Cardiac rehabilitation (CR) has shown clinical benefit in heart transplant (HT) recipients. However, variable adherence with CR has been reported. We aimed to describe adherence and factors associated with CR cessation. Methods We performed a retrospective chart review of HT recipients who attended at least one CR session at a tertiary medical center (2013-2021). Complete adherence was defined as participation in all 36 CR sessions. We extracted participant age, sex, race, BMI, diabetes, creatinine clearance, post-operative complications (reoperation, major bleeding, infection, or need for dialysis), hospital length of stay, and METs on baseline exercise tolerance test prior to CR. We computed the proportion of HT recipients who did not complete CR, and then compared their characteristics to those of HT recipients with complete adherence using Kruskal Wallis tests and Fisher's Exact tests for continuous and categorical variables, respectively. Primary reasons for cessation were extracted from the electronic health record. Results There were 55 HT recipients (median age 55.9 years, 67.3% male) who attended CR;25 (45.5%) had complete adherence. Thirty did not complete CR (14 patients attended 1-12 sessions, 12 patients attended 13-24 sessions, and 4 patients attended 25-35 sessions) and participated in a median of 13 sessions (IQR 9-21). Within this group, 46.7% reported medical reasons for cessation, 20.0% for personal reasons, 13.3% for COVID-19 pandemic, 6.7% for insurance expense, 3.3% for relocation, and 3.3% for return to work or school. Patients who did not complete CR experienced more post-operative complications after HT (63.3% vs 32.0%, p = 0.03) but there were no other differences in characteristics between groups. Conclusion Nearly half of HT recipients in our sample had complete adherence to CR. Among those who did not complete CR, medical reasons were most commonly cited. Postoperative complications predicted CR cessation, but there were no other differences between groups, albeit with a relatively small sample size.Copyright © 2023 American College of Cardiology Foundation