Predictors of non-participation in a cardiac telerehabilitation programme: a prospective analysis

Rutger Willem Maurice Brouwers; Alberto Brini; Robin Wilhelmus Franciscus Henricus Kuijpers; Jozua Johannes Kraal; Hareld Marijn Clemens Kemps

doi:10.1093/ehjdh/ztab105

Predictors of non-participation in a cardiac telerehabilitation programme: a prospective analysis

Eur Heart J Digit Health. 2021 Dec 10;3(1):81-89. doi: 10.1093/ehjdh/ztab105. eCollection 2022 Mar.

Authors

Rutger Willem Maurice Brouwers^{1

2}, Alberto Brini³, Robin Wilhelmus Franciscus Henricus Kuijpers^{1

2}, Jozua Johannes Kraal⁴, Hareld Marijn Clemens Kemps^{1

2

5}

Affiliations

¹ Department of Cardiology, Máxima Medical Center, De Run 4600, Postbus 7777, 5500 MB Veldhoven, The Netherlands.
² Vitality Center, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands.
³ Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
⁴ Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
⁵ Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.

Abstract

Aims: Current cardiac telerehabilitation (CTR) interventions are insufficiently tailored to the preferences and competences of individual patients, which raises the question whether their implementation will increase overall participation and adherence to cardiac rehabilitation (CR). However, research on patient-specific factors that influence participation and adoption of CTR interventions is scarce. The aim of this study was to evaluate which patient-related characteristics influence participation in a novel CTR intervention in patients with coronary artery disease.

Methods and results: This prospective observational substudy of the SmartCare-CAD randomized controlled trial evaluated patient characteristics of study participants as proxy for participation in a CTR intervention. We compared demographic, geographic, and health-related characteristics between trial participants and non-participants to determine which characteristics influenced trial participation. A total of 699 patients (300 participants and 399 non-participants; 84% male, mean age 64.3 ± 10.5 years) were included. Most of the non-participants refused participation because of insufficient technical skills or lack of interest in digital health (26%), or preferred centre-based CR (21%). Variables independently associated with non-participation included: higher age, lower educational level, shorter travelling distance, smoking, positive family history for cardiovascular disease, having undergone coronary artery bypass grafting; and a higher blood pressure, worse exercise capacity, and higher risk of depression before the start of CR.

Conclusion: Participation in CTR is strongly influenced by demographic and health-related factors such as age, educational level, smoking status, and both physical and mental functioning. Cardiac telerehabilitation interventions should therefore be redesigned with the involvement of these currently underrepresented patient subgroups.

Keywords: Cardiac rehabilitation; Cardiac telerehabilitation; Coronary artery disease; Participation; Telemonitoring.