The role of lifestyle and cardiovascular risk factors in dropout from an Australian cardiac rehabilitation program : a longitudinal cohort study

Background: Cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. However, many people who experience a cardiac event do not attend or fail to complete their CR program. Little is known about the characteristics of people who drop out compared to those who complete CR. Aims: To identify subgroups of patients attending a cardiac rehabilitation program who are more likely to dropout prior to final assessment by (1) calculating the dropout rate from the program, (2) quantifying the association between dropout and socio-demographic, lifestyle, and cardiovascular risk factors, and (3) identifying independent predictors of dropout. Methods: The study population is from a large metropolitan teaching hospital in Sydney, Australia, and consists of all participants consecutively enrolled in an outpatient CR program between 2006 and 2017. Items assessed included diagnoses and co-morbidities, quality of life (SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as failure to complete the outpatient CR program and post CR assessment. Results: Of the 3,350 patients enrolled in the CR program, 784 (23.4%; 95%CI: 22.0–24.9%) dropped out prior to completion. The independent predictors of dropout were smoking (OR 2.4; 95%CI: 1.9–3.0), being separated or divorced (OR 2.0; 95%CI: 1.5–2.6), younger age (<55 years) (OR 1.9; 95%CI: 1.6–2.4), obesity (OR 1.6; 95%CI: 1.3–2.0), diabetes (OR 1.6; 95%CI: 1.3–2.0), sedentary lifestyle (OR 1.3; 95%CI: 1.1–1.6) and depressive symptoms (OR 1.3; 95%CI: 1.1–1.6). Conclusion: To improve the CR program completion rate, clinicians need to consider the impact of socio-demographic, lifestyle, and cardiovascular risk factors on their patients’ ability to complete CR. Tailored strategies which target the independent predictors of dropout are required to promote adherence to CR programs and thereby potentially reduce long-term cardiovascular risk.