Expectation, satisfaction, and predictors of dropout in cardiac rehabilitation

Despite the evidence of benefit many patients fail to adhere to cardiac rehabilitation (CR). This study aims at describing the rate, reasons, and predictors of dropout from CR, as well as expectations und satisfaction among participants.

Prospective analysis of demographic, medical, and psychosocial data in a large cohort of consecutive participants of outpatient CR.

Between 1999 and 2008, 2521 consecutive patients were enrolled in CR and complete data for analysis were available in 2371 patients. Diagnoses were coronary heart disease in 85%, valvular heart disease in 15%, and other in 10%. Mean age was 59.7 ± 11.4 years; 85% were male. Specific expectations towards CR were identified in a subgroup of participants and satisfaction was high in 75% of patients. Early dropout was noted in 305 patients (12.9%); reasons for dropout were cardiac in 39 (1.7%) and non-cardiac in 266 (11.2%). Significant differences between dropouts vs. completers were: peak exercise capacity (116 ± 41 vs. 123 ± 39 Watt, p = 0.003); body mass index (28 ± 7 vs. 27 ± 4 kg/m², p = 0.04); prevalence of diabetes (18 vs. 13%, p = 0.011); smoking (32 vs. 16%, p < 0.001); being professionally active (24 vs. 34%, p = 0.007); widowhood (8 vs. 3%, p = 0.04); higher education (37.5 vs. 46.4%, p = 0.003); white collar work (21 vs. 27%, p = 0.012); and scales of a quality-of-life score (p < 0.02). Multivariate analysis revealed low exercise capacity, high body mass index, smoking, diabetes, and widowhood to be significant independent predictors for early dropout.

In the present study we demonstrated a low rate of mainly non-cardiac dropout from outpatient CR in motivated and largely satisfied participants. In order to improve adherence, early attention and close supportive counselling is recommended in patients with low exercise capacity and those who are obese, diabetic, smokers, or bereaved of a partner.