TY - JOUR
T1 - Development of a simple clinical tool for predicting early dropout in cardiac rehabilitation a single-center risk model
AU - Pack, Quinn R.
AU - Visintainer, Paul
AU - Farah, Michel
AU - LaValley, Grace
AU - Szalai, Heidi
AU - Lindenauer, Peter K.
AU - Lagu, Tara
N1 - Funding Information:
Drs Pack, Lagu, and Lindenauer were each supported by grants from the National Heart, Lung and Blood Institute of the National Institutes of Health of Bethesda, Maryland, under award numbers 1K23HL135440, R01HL146884, and 1K24HL132008, respectively.
Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - Background: Nonadherence to cardiac rehabilitation (CR) is common despite the benefits of completing a full program. Adherence might be improved if patients at risk of early dropout were identified and received an intervention. Methods: Using records from patients who completed =1 CR session in 2016 (derivation cohort), we employed multivariable logistic regression to identify independent patient-level characteristics associated with attending <12 sessions of CR in a predictive model. We then evaluated model discrimination and validity among patients who enrolled in 2017 (validation cohort). Results: Of the 657 patients in our derivation cohort, 318 (48%) completed <12 sessions. Independent risk factors for not attending =12 sessions were age <55 yr (OR = 0.23, P < .001), age 55 to 64 yr (OR = 0.35, P < .001), age =75 yr (OR = 0.64, P = .06), smoker within 30 d of CR enrollment (OR = 0.40, P = .001), low risk for exercise adverse events (OR = 0.54, P = .03), and nonsurgical referral diagnosis (OR = 0.66, P = .02). Our model predicted nonadherence risk from 23-90%, had acceptable discrimination and calibration (C-statistics = 0.70, Harrell’s E50 and E90 2.0 and 3.6, respectively) but had fair validity among 542 patients in the validation cohort (C-statistic = 0.62, Harrell’s E50 and E90 2.1 and 11.3, respectively). Conclusion: We developed and evaluated a single-center simple risk model to predict nonadherence to CR. Although the model has limitations, this tool may help clinicians identify patients at risk of early dropout and guide intervention efforts to improve adherence so that the full benefits of CR can be realized for all patients.
AB - Background: Nonadherence to cardiac rehabilitation (CR) is common despite the benefits of completing a full program. Adherence might be improved if patients at risk of early dropout were identified and received an intervention. Methods: Using records from patients who completed =1 CR session in 2016 (derivation cohort), we employed multivariable logistic regression to identify independent patient-level characteristics associated with attending <12 sessions of CR in a predictive model. We then evaluated model discrimination and validity among patients who enrolled in 2017 (validation cohort). Results: Of the 657 patients in our derivation cohort, 318 (48%) completed <12 sessions. Independent risk factors for not attending =12 sessions were age <55 yr (OR = 0.23, P < .001), age 55 to 64 yr (OR = 0.35, P < .001), age =75 yr (OR = 0.64, P = .06), smoker within 30 d of CR enrollment (OR = 0.40, P = .001), low risk for exercise adverse events (OR = 0.54, P = .03), and nonsurgical referral diagnosis (OR = 0.66, P = .02). Our model predicted nonadherence risk from 23-90%, had acceptable discrimination and calibration (C-statistics = 0.70, Harrell’s E50 and E90 2.0 and 3.6, respectively) but had fair validity among 542 patients in the validation cohort (C-statistic = 0.62, Harrell’s E50 and E90 2.1 and 11.3, respectively). Conclusion: We developed and evaluated a single-center simple risk model to predict nonadherence to CR. Although the model has limitations, this tool may help clinicians identify patients at risk of early dropout and guide intervention efforts to improve adherence so that the full benefits of CR can be realized for all patients.
KW - Adherence
KW - Cardiac rehabilitation
KW - Dropout
KW - Prediction
KW - Risk
KW - Utilization
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U2 - 10.1097/HCR.0000000000000541
DO - 10.1097/HCR.0000000000000541
M3 - Article
C2 - 32947327
AN - SCOPUS:85105833393
VL - 41
SP - 159
EP - 165
JO - Journal of Cardiopulmonary Rehabilitation and Prevention
JF - Journal of Cardiopulmonary Rehabilitation and Prevention
SN - 1932-7501
IS - 3
ER -