Are patient characteristics and modes of delivery associated with completion of cardiac rehabilitation? A national registry analysis. (15th August 2022) - Tang, Lars Hermann
Abstract: Aim: To achieve effectiveness and reduce inequality in everyday cardiac rehabilitation, this study aims to compare individual patient characteristics along with completion rates to traditional and evolving modes of delivery in cardiac rehabilitation. Method: Patients were included from the UK National Audit of Cardiac Rehabilitation (NACR) database. All patients with coronary heart disease (≥18 years) between the 1st of January 2014 to 31st of December 2019 that started core rehabilitation with a recorded mode of cardiac rehabilitation delivery were eligible. Modes of delivery were divided into: centre-based, home-based, and hybrid. Logistic regression models were used to investigate association between modes of delivery and completion adjusting for patient demographics. Result: In total 182, 722 patients had mode of delivery recorded: 72.8% centre-based, 8.3% home-based and 18.9% hybrid. The home-based mode in comparison to hybrid and centre-based had significantly higher rates of females, single, white, and unemployed patients ( p < 0.001). There was a higher proportion of cardiovascular risk factors in home-based than the other modes (p < 0.001). There was a reduced likelihood of completing home-based cardiac rehabilitation compared to centre-based with an odds ratio of 0.66, (95% CI: 0.48 to 0.91) but no significant difference between hybrid and centre-based modes (odds ratio, 1.18; 95% CI 0.92 to 1.51). Conclusions: From large real-world data, home-based modes of delivery appear to have significantly lower levels of completion than centre-based modes. Cardiac rehabilitation programs offering home-based and hybrid delivery modes need to be structured to ensure adequacy of completion. Highlights: The population receiving cardiac rehabilitation was significantly different between the home-based and the centre-based and hybrid modes The rate of non-completion in the home-based mode was higher than the other modes and had different subgroups of patients not-completing Accounting for other predictors the home-based mode has significantly lower completion (34 % reduced likelihood) compared to centre-based mode Cardiac rehabilitation programs offering home-based and hybrid delivery modes need to be structured to ensure adequacy of completion