Patient factors associated 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 (1). Cardiac rehabilitation (CR) is a secondary prevention model of care for cardiac patients. It is proven that CR reduces cardiovascular mortality by 20% (2). However, CR is underutilized worldwide, with low enrolment and adherence rates (3). This study aims (a) to investigate factors associated with adherence (median number of sessions, i.e. 21), and (b) to examine the relationship between adherence and change in cardiac risk factors, i.e. blood pressure, cholesterol, and low-density lipoprotein (LDL). Method: This retrospective cohort study included 714 cardiac patients, aged ≥18 years, who were referred to the cardiac rehabilitation program in Qatar. Data were collected from patients records from January 2013-September 2018. Logistic regression models were used to assess factors associated with adherence. Multiple linear regression models were used to examine the relationship between the number of CR sessions attended and changes in cardiac risk factors. Results: The mean age of the study population was 52.7±10.1 years (mean ± SD). The majority of patients were males (n=641, 89.8%) and non-Qatari (n= 596, 83.5%),i.e. similar to Qatar population profile of 75% males and 15% Qatari, one fourth were smokers (n=185, 25.91%), and one fifth (n=128, 18.8%) had severe depression. Patients with AACVPR moderate- and high-risk levels were more likely to adhere compared to those with low risk. PCI and musculoskeletal disease were negatively associated with adherence. We found clinically significant improvements among adherents compared to non-adherents; reduction of 10% in cholesterol, and 15% in LDL. Conclusion: This study provides new insights in Qatar setting into factors that lead patients to adhere to their CR sessions. These factors represent opportunities for targeted interventions to improve CR utilization