Expectation, satisfaction, and predictors of dropout in cardiac rehabilitation.

BACKGROUND: Despite the evidence of benefit many patients fail to adhere to cardiac rehabilitation (CR). This study aims at describing the rate, reasons, and predictors of dropout from CR, as well as expectations und satisfaction among participants. METHODS: Prospective analysis of demographic, medical, and psychosocial data in a large cohort of consecutive participants of outpatient CR. RESULTS: Between 1999 and 2008, 2521 consecutive patients were enrolled in CR and complete data for analysis were available in 2371 patients. Diagnoses were coronary heart disease in 85%, valvular heart disease in 15%, and other in 10%. Mean age was 59.7 ± 11.4 years; 85% were male. Specific expectations towards CR were identified in a subgroup of participants and satisfaction was high in 75% of patients. Early dropout was noted in 305 patients (12.9%); reasons for dropout were cardiac in 39 (1.7%) and non-cardiac in 266 (11.2%). Significant differences between dropouts vs. completers were: peak exercise capacity (116 ± 41 vs. 123 ± 39 Watt, p = 0.003); body mass index (28 ± 7 vs. 27 ± 4 kg/m(2), p = 0.04); prevalence of diabetes (18 vs. 13%, p = 0.011); smoking (32 vs. 16%, p < 0.001); being professionally active (24 vs. 34%, p = 0.007); widowhood (8 vs. 3%, p = 0.04); higher education (37.5 vs. 46.4%, p = 0.003); white collar work (21 vs. 27%, p = 0.012); and scales of a quality-of-life score (p < 0.02). Multivariate analysis revealed low exercise capacity, high body mass index, smoking, diabetes, and widowhood to be significant independent predictors for early dropout. CONCLUSION: In the present study we demonstrated a low rate of mainly non-cardiac dropout from outpatient CR in motivated and largely satisfied participants. In order to improve adherence, early attention and close supportive counselling is recommended in patients with low exercise capacity and those who are obese, diabetic, smokers, or bereaved of a partner.

Sexual Dysfunction before and after Cardiac Rehabilitation.

Background. The aim of this study was to assess sexual function before and after cardiac rehabilitation in relation to medical variables. Methods. Analysis of patients participating in a 12-week exercise-based outpatient cardiac rehabilitation program (OCR) between April 1999 and December 2007. Exercise capacity (ExC) and quality of life including sexual function were assessed before and after OCR. Results. Complete data were available in 896 male patients. No sexual activity at all was indicated by 23.1% at baseline and 21.8% after OCR, no problems with sexual activity by 40.8% at baseline and 38.6% after OCR. Patients showed an increase in specific problems (erectile dysfunction and lack of orgasm) from 18% to 23% (P < .0001) during OCR. We found the following independent positive and negative predictors of sexual problems after OCR: hyperlipidemia, age, CABG, baseline ExC and improvement of ExC, subjective physical and mental capacity, and sense of affiliation. Conclusions. Sexual dysfunction is present in over half of the patients undergoing OCR with no overall improvement during OCR. Age, CABG, low exercise capacity are independent predictors of sexual dysfunction after OCR.

Prognostic value of cycle exercise testing prior to and after outpatient cardiac rehabilitation.

BACKGROUND: The prognostic value of cycle exercise testing prior to and after outpatient cardiac rehabilitation (OCR) is not well established. METHODS: 2146 consecutive patients undergoing symptom-limited cycle exercise testing at OCR entry, of whom 1853 (86%) also had a test at end of OCR, were followed for a median of 33 months. RESULTS: All-cause and cardiovascular annual mortality rates were 1.2% and 0.8%, respectively. At OCR entry, older age, diabetes, lower left ventricular ejection fraction (LVEF), calcium channel blocker use, and lower workload [hazard ratio (HR) 2.38 if < or = 105 W; p<0.001] were independent predictors of death. Diabetes, diuretic use, and lower workload [HR 3.53 if < or = 105 W; p=0.001] were independently associated with cardiovascular death. At end of OCR, older age, lower LVEF, lower workload (HR 2.34 if <140 W; p=0.009), and lower increase in peak heart rate from entry to end of OCR (HR 2.46 if <4 bpm; p=0.002) were independently associated with all-cause mortality. Older age, lower LVEF, lower increase in systolic blood pressure (HR 2.97 if <54 mm Hg; p=0.02), and lower increase in peak heart from entry to end of OCR (HR 2.72 if <4 bpm; p=0.013) were independently associated with cardiovascular mortality. Failure to undergo a test at end of OCR was an additional independent predictor of all-cause (HR 2.51; p<0.001) and cardiovascular mortality (HR 2.56; p=0.003). CONCLUSION: Symptom-limited cycle exercise testing prior to and after OCR provides important prognostic information.