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Correlations between components of cardiac rehabilitation and attaining risk factor goals after myocardial infarction - the Perfect-CR study

Session Poster session 4

Speaker Halldora Ogmundsdottir Michelsen

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : H Ogmundsdottir Michelsen (Malmo,SE), E Hagstrom (Uppsala,SE), I Sjolin (Malmo,SE), M Schlyter (Malmo,SE), A Kiessling (Stockholm,SE), C Held (Uppsala,SE), E Hag (Jonkoping,SE), L Nilsson (Linkoping,SE), A Schiopu (Malmo,SE), MJ Zaman (Norfolk,GB), M Leosdottir (Malmo,SE)

Authors:
H. Ogmundsdottir Michelsen1 , E. Hagstrom2 , I. Sjolin1 , M. Schlyter1 , A. Kiessling3 , C. Held2 , E. Hag4 , L. Nilsson5 , A. Schiopu1 , M.J. Zaman6 , M. Leosdottir1 , 1Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University - Malmo - Sweden , 2Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center - Uppsala - Sweden , 3Danderyd University Hospital, 3Department of Clinical Sciences and Karolinska Institute - Stockholm - Sweden , 4Ryhov County Hospital, Department of Internal Medicine - Jonkoping - Sweden , 5Linkoping University, Department of Medical and Health Sciences - Linkoping - Sweden , 6James Paget University Hospital, Department of Cardiology - Norfolk - United Kingdom ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 716

Background: The relative contribution of different components of cardiac rehabilitation (CR) to secondary prevention success has been highlighted in guidelines as a remaining gap in evidence.

Purpose: To assess the importance of different CR components on attaining risk factor goals after myocardial infarction (MI).

Methods: We performed a survey-based analysis of working routines followed at CR centres in Sweden 2016. An index was designed, including 37 components recommended in guidelines as cornerstones of CR. Centres were scored 0–30 points based on how many components they met. Correlations between the index components and the Swedish Secondary Prevention Registry risk factor outcome measure called Q4 (includes whether goals for blood pressure and lipids are reached, if the patient has participated in exercise training and is a non-smoker at one year post-MI) were evaluated. The degree of explanation (R2) for the variance in Q4 was assessed by linear regression, including variables with the strongest correlations (R≥0.20) to Q4.

Results: The CR index score ranged from 2–29 (median 23.0, SD ±4.5; Fig 1). The R-value for the correlation between the CR index score and Q4 was 0.46 (p=0.0005). Ten variables showing the strongest individual correlation with Q4 are shown in Table 1. Jointly these explained 25% of the adjusted variance in Q4 (p=0.01).

Conclusions: Components of CR with the strongest correlation with risk factor outcomes post-MI included having a medical director, nurses' autonomy to adjust medication, regular case rounds, and using registry data to improve quality of care at the CR centre. The results underline the importance of a structured and professional CR team for success.

Table 1. Ten working routines in cardiac rehabilitation showing the strongest individual correlation (R ≥2.0) with risk factor outcomes post-MI
Rp-value
The CR centre has a designated medical director (cardiologist)0.370.003
Our nurses independently adjust statins0.320.01
Material on healthy diet is distributed at first follow-up visit with a nurse0.310.01
Our nurses have regular rounds with a CR cardiologist to discuss patient cases0.270.03
Registry data is used on a regular basis to improve quality of care0.260.03
Our patients are provided with written information on their risk factor goals at the first follow-up visit with a nurse0.250.04
Our patients are provided with written information on healthy lifestyle at the first follow-up visit with a nurse0.240.04
Our patients meet with a physiotherapist before discharge from the hospital0.220.05
We have had low employee turnover in the CR team for the last two years (all or most of the staff are the same)0.220.06
Our nurses independently adjust blood pressure medication0.200.08
Figure 1

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