The challenge of non-adherence to early rehabilitation after coronary artery bypass surgery: Secondary results from the SheppHeartCABG trial

Ida E Højskov; Lau C Thygesen; Philip Moons; Ingrid Egerod; Peter S Olsen; Selina K Berg

doi:10.1177/1474515119883454

The challenge of non-adherence to early rehabilitation after coronary artery bypass surgery: Secondary results from the SheppHeartCABG trial

Eur J Cardiovasc Nurs. 2020 Mar;19(3):238-247. doi: 10.1177/1474515119883454. Epub 2019 Oct 19.

Authors

Ida E Højskov^{1

2}, Lau C Thygesen³, Philip Moons^{4

5}, Ingrid Egerod⁶, Peter S Olsen¹, Selina K Berg¹

Affiliations

¹ The Heart Centre, University of Copenhagen, Denmark.
² Department of Nursing and Nutrition Education. The Faculty of Health Sciences, University College, Copenhagen, Denmark.
³ National Institute of Public Health, University of Southern Denmark, Denmark.
⁴ Department of Public Health and Primary Care, University of Leuven, Belgium.
⁵ Department of Pediatrics and Child Health, University of Cape Town, South Africa.
⁶ Department of Intensive Care Unit, Rigshospitalet, University of Copenhagen, Denmark.

PMID: 31630532
DOI: 10.1177/1474515119883454

Abstract

Background: Attending and maintaining a cardiac rehabilitation programme is a challenge.

Aims: The purpose of this study was to explore associations between non-adherence to early coronary artery bypass graft rehabilitation and sociodemographic and clinical baseline data.

Methods: Coronary artery bypass graft patients were randomised 1:1 to either four weeks of comprehensive early rehabilitation or usual care. Outcomes were assessed at three time-points points: baseline, discharge and four weeks post-coronary artery bypass graft. Differences in sociodemographic and clinical baseline data in adherent versus non-adherent patients were tested using the Pearson χ² test for categorical variables. To test associations between non-adherence to exercise training and sociodemographic and clinical baseline data, multivariate logistic regression was used to estimate the odds ratio for in-hospital training and post-discharge training adjusted for age, sex and left ventricular ejection fraction.

Results: Non-adherence to in-hospital versus post-discharge exercise training was 31% (n=48) versus 53% (n=81). Female non-adherence was 20% versus 70%. Non-adherence to in-hospital versus post-discharge mindfulness was 87% versus 70%. Male non-adherence to mindfulness was 85% versus 70%. Non-adherence to psycho-educational consultations was 3%, most of whom were men. Patients with university level education were more adherent to in-hospital exercise training than patients with lower educational level (odds ratio=3.14 (95% confidence interval; 1.16-8.51), p=0.02). Diabetic patients were more non-adherent to exercise training after discharge (3.74 (1.54-9.08), p=0.004) as were overweight patients (0.37 (0.17-0.80), p=0.01).

Conclusions: This study demonstrated wide acceptance of psycho-educational consultations in post-coronary artery bypass graft patients. Adherence to physical rehabilitation was low especially after discharge from hospital and the opportunity to attend a mindfulness programme was not used.

Keywords: Adherence; coronary artery bypass grafting; early rehabilitation; exercise psycho-education.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aftercare / psychology*
Aftercare / statistics & numerical data
Age Factors
Aged
Aged, 80 and over
Cardiac Rehabilitation / psychology*
Cardiac Rehabilitation / statistics & numerical data*
Coronary Artery Bypass / rehabilitation*
Exercise Therapy / methods
Exercise Therapy / psychology*
Exercise Therapy / statistics & numerical data
Female
Humans
Male
Middle Aged
Patient Compliance / psychology*
Patient Compliance / statistics & numerical data*
Sex Factors
Socioeconomic Factors