open access

Vol 67, No 6 (2009)
Other
Published online: 2009-06-24
Submitted: 2012-12-28
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Original article
Why patients after acute coronary syndromes do not participate in an early outpatient rehabilitation programme?

Ewa Deskur-Śmielecka, Sławomira Borowicz-Bieńkowska, Aleksandra Brychcy, Małgorzata Wilk, Izabela Przywarska, Piotr Dylewicz
Kardiol Pol 2009;67(6):632-638.

open access

Vol 67, No 6 (2009)
Other
Published online: 2009-06-24
Submitted: 2012-12-28

Abstract

Background: The value of cardiac rehabilitation in patients with coronary artery disease has been well established. The main problem is a low attendance of patients qualified for rehabilitation.
Aim: To assess differences between subjects attending outpatient cardiac rehabilitation (OutCR) after completing an early inpatient programme (InCR), and patients refusing participation in OutCR; to investigate factors determining patients’ decisions.
Methods: Seventy-two patients (mean age 57 ± 9.4 years; 53 men) 2-3 weeks after an acute coronary syndrome (ACS) treated with primary PCI were enrolled. On admission to the cardiac rehabilitation ward, the following parameters were assessed: quality of life (EuroQol-5D questionnaire), psychological status (Beck’s, SOPER and STAI questionnaires), marital status, education, economic status, employment, place of living, smoking status, and comorbidities (a questionnaire prepared by the authors). Additionally, patients’ opinions on outpatient and inpatient cardiac rehabilitation were noted. The inpatient programme lasted 2-3 weeks. At discharge, the assessment was repeated, and patients were proposed to enrol in a 12-week outpatient programme. In the case of refusal, patients were asked to give the reason.
Results: Two men failed to complete the inpatient program. Of the remaining 70 subjects, 16 attended and completed the outpatient programme. In the group participating in OutCR, there were fewer patients with depression before InCR (12 vs. 39% in the group without OutCR, p = 0.0484). Subjects in the OutCR group had a higher score for mood after InCR (7.7 ± 1.25 vs. 6.7 ± 1.69, p = 0.0365), lower score for emotional stress before and after InCR (before InCR: 4.4 ± 1.09 vs. 5.3 ± 1.34, p = 0.0188; after InCR: 3.8 ± 1.51 vs. 4.8 ± 1.4, p = 0.0262), and lower score for anxiety before InCR (3.1 ± 1.75 vs. 4.4 ± 2.12, p = 0.0426). Patients in the two groups differed with regard to employment (p = 0.0256) and smoking status (p = 0.0517). In both groups, most patients (ł 80%) preferred inpatient rehabilitation. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation.
Conclusions: Only a small proportion of patients after an ACS decides to participate in outpatient rehabilitation after completing a short-term inpatient programme. Psychological status, employment and smoking status are among the factors that differentiate OutCR attenders and non-attenders. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation.

Abstract

Background: The value of cardiac rehabilitation in patients with coronary artery disease has been well established. The main problem is a low attendance of patients qualified for rehabilitation.
Aim: To assess differences between subjects attending outpatient cardiac rehabilitation (OutCR) after completing an early inpatient programme (InCR), and patients refusing participation in OutCR; to investigate factors determining patients’ decisions.
Methods: Seventy-two patients (mean age 57 ± 9.4 years; 53 men) 2-3 weeks after an acute coronary syndrome (ACS) treated with primary PCI were enrolled. On admission to the cardiac rehabilitation ward, the following parameters were assessed: quality of life (EuroQol-5D questionnaire), psychological status (Beck’s, SOPER and STAI questionnaires), marital status, education, economic status, employment, place of living, smoking status, and comorbidities (a questionnaire prepared by the authors). Additionally, patients’ opinions on outpatient and inpatient cardiac rehabilitation were noted. The inpatient programme lasted 2-3 weeks. At discharge, the assessment was repeated, and patients were proposed to enrol in a 12-week outpatient programme. In the case of refusal, patients were asked to give the reason.
Results: Two men failed to complete the inpatient program. Of the remaining 70 subjects, 16 attended and completed the outpatient programme. In the group participating in OutCR, there were fewer patients with depression before InCR (12 vs. 39% in the group without OutCR, p = 0.0484). Subjects in the OutCR group had a higher score for mood after InCR (7.7 ± 1.25 vs. 6.7 ± 1.69, p = 0.0365), lower score for emotional stress before and after InCR (before InCR: 4.4 ± 1.09 vs. 5.3 ± 1.34, p = 0.0188; after InCR: 3.8 ± 1.51 vs. 4.8 ± 1.4, p = 0.0262), and lower score for anxiety before InCR (3.1 ± 1.75 vs. 4.4 ± 2.12, p = 0.0426). Patients in the two groups differed with regard to employment (p = 0.0256) and smoking status (p = 0.0517). In both groups, most patients (ł 80%) preferred inpatient rehabilitation. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation.
Conclusions: Only a small proportion of patients after an ACS decides to participate in outpatient rehabilitation after completing a short-term inpatient programme. Psychological status, employment and smoking status are among the factors that differentiate OutCR attenders and non-attenders. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation.
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Keywords

cardiac rehabilitation; quality of life; depression; anxiety; socioeconomic status

About this article
Title

Original article
Why patients after acute coronary syndromes do not participate in an early outpatient rehabilitation programme?

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 67, No 6 (2009)

Pages

632-638

Published online

2009-06-24

Bibliographic record

Kardiol Pol 2009;67(6):632-638.

Keywords

cardiac rehabilitation
quality of life
depression
anxiety
socioeconomic status

Authors

Ewa Deskur-Śmielecka
Sławomira Borowicz-Bieńkowska
Aleksandra Brychcy
Małgorzata Wilk
Izabela Przywarska
Piotr Dylewicz

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