Patient Factors Associaed With Adherence And Change In Cardiac Risk Factors Among Cardiac Rehabilitation Patients In Qatar

Abstract

Background: cardiovascular disease is the number one killer in Qatar. Cardiac rehabilitation (CR) is a cost-effective model of care shown to reduce cardiovascular morbidity and mortality by 20%. However, it is vastly underutilized with low enrollment and adherence rates. This study aimed to (a) examine the association between number of sessions attended and change in cardiac risk factors after completion of CR program, and (b) investigate factors associated with adherence Methods: This is a retrospective cohort study, consisted of 714 cardiac patients, aged ≥18 years, referred to a cardiac rehabilitation program in Qatar. A simple linear regression analysis (unadjusted model) was used to assess the association between the mean change in each of the following risk factors: cholestrol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and body mass index (BMI and number of sessions attended. Then, we adjusted for clinical and sociodemographic factors that affect the outcome variable via multiple linear regression analyses. Logistic regression model was used to assess factors associated with adherence. Additionally, a paired sample t-test was used to identify mean change in cardiac risk factors pre-post CR and link this change to clinical significant cut off values in the literature. An independent sample t-test was used to identify change between groups (adherence vs. no adherence). Result: The mean age of the population was 52.7±10.1 years (mean ± SD). Patients referred to CR program were mostly males (n= 641, 89.8%) and non-Qatari (n= 596, 83.5%), almost one fourth were smokers (n=185, 25.91%), and one fifth (n=128, 18.8%) were diagnosed with severe depression. The main positive predictor for adherence was AACVPR moderate risk [OR=12.71, 95%CI= 7.81-20.68] and high-risk level [OR=10, 95%CI= 6.44-17.44]. PCI [OR=0.39, 95%CI= 0.17-0.89] and musculoskeletal disease [OR=0.17, 95%CI= 0.03-0.95] were negatively associated with adherence. We found clinically significant improvements among adherents to CR; 10% reduction in total cholesterol level and 15% reduction in low-density lipoproteins. Conclusion: This study provides new insights in Qatar setting into the factors that lead patients to adhere to their CR sessions. These patient-level variables associated with adherence represent opportunities for program directors in identifying patients who are less likely to adhere to the program; therefore, develope effective interventions to target these patients and consequently improve their health status.