Estudio de adherencia en rehabilitación cardiacaprevalencia, barreras, factores predictivos y soluciones potenciales con especial referencia a los condicionantes laborales y de género

Resum

Cardiac rehabilitation (CR) is a key component of the continuum of care for patients with CVD that reduces mortality, morbidity and rehospitalization. CR has the highest level of scientific evidence (I) and the highest grade recommendation (A) in clinical practice guidelines for the care of patients with CVD. Although there are multiple studies on barriers and solutions to improve the initiation rates of cardiac rehabilitation programs (CRP), a limited number of studies have explored the barriers and solutions to increase the degree of compliance in CRP. The aim of this work is to define those characteristics that predict differences in patient CRP completion with special interest in women and employed patients, since the specific benefit of CR in these populations. MATERIAL AND METHODS This study was composed of two parts. First, we performed a retrospective electronic history review of the Mayo Clinic CRP, Rochester (Minnesota, USA) to identify patients who had started the Mayo Clinic program between 1/1/2014 and 9/30/2015. Among patients who met the inclusion criteria, we conducted a telephone survey with the aim of defining barriers to participation and possible solutions proposed by patients to increase CRP adherence. The survey included factors previously identified in the literature as possible barriers, as well as other hypothetical factors; including close and open-ended questions. Secondly, we conducted a qualitative study through group interviews in order to determine the barriers and possible solutions to increase adherence. The study was approved by the Mayo Clinic research committee. RESULTS 376 patients initially met the inclusion criteria. 257 patients completed the survey. 240 (63.8%) sent back the HIPAA (Health Information Use Authorization) document. 72 (30%) were women with a mean age of 66.4 ±12.4 years. Forty-seven percent (n = 113) of the participants did not complete the CR program (≤36 CR sessions). Compared to men, women showed a worse perception of quality of life (p=0.01) and were more hours/week involved in household chores (p=0.0013). Among the most important barriers, we found that schedule conflicts were more frequent among employed patients compared to non-employed patients (p=0.04). Employed patients reported a higher level of stress. Lack of motivation and an inadequate awareness of the importance of completing the CRP were frequently reported as barriers. Among the proposed solutions, the participants requested an alternative programs; as well as improving CR awareness among patients and professionals about the importance of CRP completion. CONCLUSION This study has great relevance because of the comprehensive assessment of patients’ experiences regarding CR participation through a quantitative and qualitative approach. Emotional factors and a lack of knowledge about CR highlight the need to work on increasing CR awareness among patients and healthcare professionals (whether or not they work in CR). Alternative CR programs are another possible solution that would facilitate participation, with special focus on the employed population and women, as they more frequently report logistical barriers. This study brings out the need that clinical CR physicians, occupational physicians and insurance companies should work together in order to improve CR participation and outcomes.