Treatment of the Aged Patients at a Large Cardiac Rehabilitation Center in the Southern Brazil and Some Aspects of Their Dropout from the Therapeutic Programs

Pietro Felice Tomazini Nesello; Olga Tairova; Maria Tairova; Lucas Graciolli; Allan Baroni; Eduardo Comparsi; Thiago De Marchi

doi:10.3889/oamjms.2016.125

Authors

Pietro Felice Tomazini Nesello University of Caxias do Sul, Sports Medicine Institute, Caxias do Sul
Olga Tairova University of Caxias do Sul, Cardiac Rehabilitation Service, Caxias do Sul
Maria Tairova University of Caxias do Sul, Sports Medicine Institute, Caxias do Sul
Lucas Graciolli University of Caxias do Sul, Sports Medicine Institute, Caxias do Sul
Allan Baroni University of Caxias do Sul, Sports Medicine Institute, Caxias do Sul
Eduardo Comparsi University of Caxias do Sul, Cardiac Rehabilitation Service, Caxias do Sul
Thiago De Marchi

DOI:

https://doi.org/10.3889/oamjms.2016.125

Keywords:

Age, Elderly, Dropout, Cardiac Rehabilitation Program, Coronary Artery Disease

Abstract

AIM: This paper aims to assess the dropout rate in different age groups through the example of the large cardiac rehabilitation centre affiliated with the Institute of Sports Medicine, University of Caxias do Sul.

MATERIAL AND METHODS: A historic cohort study comprising the following groups: Non-Old < 65 (n = 141); Young-Old 65-74 (n = 128); and Middle-Old 75-84 years old (n = 57). The exercise program lasted 48 sessions and dropout was defined as attendance of 50% of sessions or less. Logistic binominal regression was performed to assess the risk of dropout. For all analyses, a two-tailed P value of < 0.05 was used.

RESULTS: The total dropout rate was 38.6%. The Young-Old and Middle-Old groups showed lower dropouts compared to Non-Old patients (p = 0.01). Young-Old has 96% less risk for dropout compared to Non-Old group (adjusted odds ratios = 1.96 [1.16â€“3.29]). Furthermore, patients underwent the Coronary Artery Bypass Graft showed a lower rate of dropout (p = 0.001). The absence of CABG involved three times more risk of dropout (p = 0.001).

CONCLUSION: The Non-Old and the Middle-Old patients showed higher dropout rates compared to Young-Old. To ensure the best possible rehabilitation and to improve patientsÂ´ participation in CR, these programs should be adjusted to the needs of patients in terms of their age.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Ferrucci L, Giallauria F, Guralnik JM. Epidemiology of ageing. Radiol Clin North Am. 2008;46(4):643-52. https://doi.org/10.1016/j.rcl.2008.07.005 PMid:18922285 PMCid:PMC2692491 DOI: https://doi.org/10.1016/j.rcl.2008.07.005

Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan W, Ridaura RL, Maximova T, Arokiasamy P, Phaswana-Mafuya N, Williams S, Snodgrass JJ. Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). International Journal of Epidemiology. 2012;41(6):1639-49. https://doi.org/10.1093/ije/dys210 PMid:23283715 PMCid:PMC3535754 DOI: https://doi.org/10.1093/ije/dys210

Closs VE, Schwanke CH. A evoluÃ§Ã£o do Ãndice de envelhecimento no Brasil, nas suas regiÃµes e unidades federativas no perÃodo de 1970 a 2010. Rev Bras Geriatr Gerontol. 2012;15(3):443-58. https://doi.org/10.1590/S1809-98232012000300006 DOI: https://doi.org/10.1590/S1809-98232012000300006

MinistÃ©rio da SaÃºde (Org.). DATASUS. Brasil: InformaÃ§Ãµes de SaÃºde, 2012.

Onishi T, Shimada K, Sato H, Seki E, Watanabe Y, Sunayama S, Ohmura H, Masaki Y, Nishitani M, Fukao K, Kume A, Sumide T, Mokuno H, Naito H, Kawai S, Daida H. Effects of phase III cardiac rehabilitation on mortality and cardiovascular events in elderly patients with stable coronary artery disease. Circ J. 2010;74(4):709-14. https://doi.org/10.1253/circj.CJ-09-0638 PMid:20208382 DOI: https://doi.org/10.1253/circj.CJ-09-0638

Ribeiro AL, Duncan BB, Brant LC, Lotufo PA, Mill JG, Barreto SM. Cardiovascular Health in Brazil: Trends and Perspectives. Circulation. 2016;133(4):422-33. https://doi.org/10.1161/CIRCULATIONAHA.114.008727 PMid:26811272 DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.008727

Herdy AH, LÃ³pez-JimÃ©nez F, Terzic CP, Milani M, Stein R, Carvalho T, Serra S, Araujo CG, Zeballos PC, Anchique CV, Burdiat G, GonzÃ¡lez K, GonzÃ¡lez G, FernÃ¡ndez R, SantibÃ¡-ez C, RodrÃguez-Escudero JP, Ilarraza-LomelÃ H. South American guidelines for cardiovascular disease prevention and rehabilitation. Arq Bras Cardiol. 2014;103(2 Suppl 1):1-31. https://doi.org/10.5935/abc.2014S003 PMid:25387466 DOI: https://doi.org/10.5935/abc.2014S003

Nesello PF, Foletto G, Comparsi EP, Tairova OS. Change in Profile of Entrants in a Brazilian Large Cardiovascular Rehabilitation Service. Open Access Macedonian Journal of Medical Sciences. 2015;3(3):384. https://doi.org/10.3889/oamjms.2015.083 PMid:27275255 PMCid:PMC4877824 DOI: https://doi.org/10.3889/oamjms.2015.083

Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007;116(15):1653-62. https://doi.org/10.1161/CIRCULATIONAHA.107.701466 PMid:17893274 DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.701466

Buttery AK, Carr-White G, Martin FC, Glaser K, Lowton K. Limited availability of cardiac rehabilitation for heart failure patients in the United Kingdom: findings from a national survey. Eur J Prev Cardiol. 2014;21(8):928-40. https://doi.org/10.1177/2047487313482286 PMid:23513012 DOI: https://doi.org/10.1177/2047487313482286

Ades PA, Waldmann ML, McCann WJ, Weaver SO. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med. 1992;152(5):1033-5. https://doi.org/10.1001/archinte.1992.00400170113021 PMid:1580707 DOI: https://doi.org/10.1001/archinte.1992.00400170113021

Beauchamp A, Worcester M, Ng A, Murphy B, Tatoulis J, Grigg L, Newman R, Goble A. Attendance at cardiac rehabilitation is associated with lower all-cause mortality after 14 years of follow-up. Heart. 2013;99(9):620-5. https://doi.org/10.1136/heartjnl-2012-303022 PMid:23213175 DOI: https://doi.org/10.1136/heartjnl-2012-303022

Sundararajan V, Bunker SJ, Begg S, Marshall R, McBurney H. Attendance rates and outcomes of cardiac rehabilitation in Victoria, 1998. Med J Aust. 2004;180(6):268-71. PMid:15012563 DOI: https://doi.org/10.5694/j.1326-5377.2004.tb05923.x

Zizza CA, Ellison KJ, Wernette CM. Total water intakes of community-living middle-old and oldest-old adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2009;64(4):481-6. https://doi.org/10.1093/gerona/gln045 PMid:19213852 PMCid:PMC2657166 DOI: https://doi.org/10.1093/gerona/gln045

Heydarpour B, Saeidi M, Ezzati P, Soroush A, Komasi S. Sociodemographic Predictors in Failure to Complete Outpatient Cardiac Rehabilitation. Annals of rehabilitation medicine. 2015;39(6):863-71. https://doi.org/10.5535/arm.2015.39.6.863 PMid:26798599 PMCid:PMC4720761 DOI: https://doi.org/10.5535/arm.2015.39.6.863

Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. Journal of the American College of Cardiology. 1993;22(3):678-83. https://doi.org/10.1016/0735-1097(93)90176-2 DOI: https://doi.org/10.1016/0735-1097(93)90176-2

Salzwedel A, Wegscheider K, Herich L, Rieck A, Strandt G, VÃ¶ller H. Impact of clinical and sociodemographic patient characteristics on the outcome of cardiac rehabilitation in older patients. Aging clinical and experimental research. 2015;27(3):315-21. https://doi.org/10.1007/s40520-014-0283-2 PMid:25365953 DOI: https://doi.org/10.1007/s40520-014-0283-2

Eder B, Hofmann P, von Duvillard SP, Brandt D, Schmid JP, Pokan R, Wonisch M. Early 4â€Week Cardiac Rehabilitation Exercise Training in Elderly Patients After Heart Surgery. Journal of cardiopulmonary rehabilitation and prevention. 2010;30(2):85-92. https://doi.org/10.1097/HCR.0b013e3181be7e32 PMid:19952770 DOI: https://doi.org/10.1097/HCR.0b013e3181be7e32

Oerkild B, Frederiksen M, Hansen JF, Simonsen L, Skovgaard LT, Prescott E. Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial. Age and ageing. 2010:afq122. PMid:20846961 DOI: https://doi.org/10.1093/ageing/afq122

Hammill BG, Curtis LH, Schulman KA, Whellan DJ. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation. 2010;121(1):63-70. https://doi.org/10.1161/CIRCULATIONAHA.109.876383 PMid:20026778 PMCid:PMC2829871 DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.876383

Wittmer M, Volpatti M, Piazzalonga S, Hoffmann A. Expectation, satisfaction, and predictors of dropout in cardiac rehabilitation. European journal of preventive cardiology. 2012;19(5):1082-8. https://doi.org/10.1177/1741826711418163 PMid:21788251 DOI: https://doi.org/10.1177/1741826711418163

Ades PA, Waldmann ML, Poehlman ET, Gray P, Horton ED, Horton ES, LeWinter MM. Exercise conditioning in older coronary patients. Submaximal lactate response and endurance capacity. Circulation. 1993;88(2):572-7. https://doi.org/10.1161/01.CIR.88.2.572 PMid:8339420 DOI: https://doi.org/10.1161/01.CIR.88.2.572

Lavie CJ, Milani RV. Disparate effects of improving aerobic exercise capacity and quality of life after cardiac rehabilitation in young and elderly coronary patients. Journal of Cardiopulmonary Rehabilitation and Prevention. 2000;20(4):235-40. https://doi.org/10.1097/00008483-200007000-00004 DOI: https://doi.org/10.1097/00008483-200007000-00004

Pasquali SK, Alexander KP, Peterson ED. Cardiac rehabilitation in the elderly. Am Heart J. 2001;142(5):748-55. https://doi.org/10.1067/mhj.2001.119134 PMid:11685158 DOI: https://doi.org/10.1067/mhj.2001.119134

Menezes AR, Lavie CJ, Milani RV, Arena RA, Church TS. Cardiac rehabilitation and exercise therapy in the elderly: Should we invest in the aged. J Geriatr Cardiol. 2012;9(1):68-75. https://doi.org/10.3724/SP.J.1263.2012.00068 PMid:22783325 PMCid:PMC3390101 DOI: https://doi.org/10.3724/SP.J.1263.2012.00068

Taylor GH, Wilson SL, Sharp J. Medical, psychological, and sociodemographic factors associated with adherence to cardiac rehabilitation programs: a systematic review. Journal of Cardiovascular Nursing. 2011;26(3):202-9. https://doi.org/10.1097/JCN.0b013e3181ef6b04 PMid:21076307 DOI: https://doi.org/10.1097/JCN.0b013e3181ef6b04

Turk-Adawi KI, Oldridge NB, Tarima SS, Stason WB, Shepard DS. Cardiac rehabilitation patient and organizational factors: what keeps patients in programs? Journal of the American Heart Association. 2013;2(5):e000418. https://doi.org/10.1161/JAHA.113.000418 PMid:24145743 PMCid:PMC3835256 DOI: https://doi.org/10.1161/JAHA.113.000418

Worcester MU, Murphy BM, Mee VK, Roberts SB, Goble AJ. Cardiac rehabilitation programmes: predictors of non-attendance and drop-out. European Journal of Cardiovascular Prevention & Rehabilitation. 2004;11(4):328-35. https://doi.org/10.1097/01.hjr.0000137083.20844.54 DOI: https://doi.org/10.1097/01.hjr.0000137083.20844.54

Pardaens S, De Smedt D, De Bacquer D, Willems AM, Verstreken S, De Sutter J. Comorbidities and Psychosocial Characteristics as Determinants of Dropout in Outpatient Cardiac Rehabilitation. The Journal of cardiovascular nursing. 2015;1-7. https://doi.org/10.1097/JCN.0000000000000296 PMid:26422639 DOI: https://doi.org/10.1097/JCN.0000000000000296

Yohannes AM, Yalfani A, Doherty P, Bundy C. Predictors of drop-out from an outpatient cardiac rehabilitation programme. Clin Rehabil. 2007;21(3):222-9. https://doi.org/10.1177/0269215506070771 PMid:17329279 DOI: https://doi.org/10.1177/0269215506070771

Mikkelsen T, Thomsen KK, Tchijevitch O. Non-attendance and drop-out in cardiac rehabilitation among patients with ischaemic heart disease. Women. 2014;31(28.7):0-5.

Sanderson BK, Phillips MM, Gerald L, DiLillo V, Bittner V. Factors associated with the failure of patients to complete cardiac rehabilitation for medical and nonmedical reasons. J Cardiopulm Rehabil. 2003;23(4):281-9. https://doi.org/10.1097/00008483-200307000-00005 PMid:12894002 DOI: https://doi.org/10.1097/00008483-200307000-00005

Ades PA, Waldmann ML, Polk DM, Coflesky JT. Referral patterns and exercise response in the rehabilitation of female coronary patients aged greater than or equal to 62 years. Am J Cardiol. 1992;69(17):1422-5. https://doi.org/10.1016/0002-9149(92)90894-5 DOI: https://doi.org/10.1016/0002-9149(92)90894-5

De Vos C, Li X, Van Vlaenderen I, Saka O, Dendale P, Eyssen M, Paulus D. Participating or not in a cardiac rehabilitation programme: factors influencing a patient's decision. European journal of preventive cardiology. 2013;20(2):341-8. https://doi.org/10.1177/2047487312437057 PMid:22345682 DOI: https://doi.org/10.1177/2047487312437057

Lemstra ME, Alsabbagh W, Rajakumar RJ, Rogers MR, Blackburn D. Neighbourhood income and cardiac rehabilitation access as determinants of nonattendance and noncompletion. Can J Cardiol. 2013;29(12):1599-603. https://doi.org/10.1016/j.cjca.2013.08.011 PMid:24404611 DOI: https://doi.org/10.1016/j.cjca.2013.08.011

Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy. 2010;15(3):220-8. https://doi.org/10.1016/j.math.2009.12.004 PMid:20163979 PMCid:PMC2923776 DOI: https://doi.org/10.1016/j.math.2009.12.004

Daly J, Sindone AP, Thompson DR, Hancock K, Chang E, Davidson P. Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review. Prog Cardiovasc Nurs. 2002;17(1):8-17. https://doi.org/10.1111/j.0889-7204.2002.00614.x PMid:11872976 DOI: https://doi.org/10.1111/j.0889-7204.2002.00614.x