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Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction : The Perfect-CR study

Michelsen, Halldora Ögmundsdottir LU orcid ; Henriksson, Peter ; Wallert, John ; Bäck, Maria ; Sjölin, Ingela LU ; Schlyter, Mona ; Hagström, Emil ; Kiessling, Anna ; Held, Claes and Hag, Emma , et al. (2023) In International Journal of Cardiology 371. p.40-48
Abstract

Background: Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI. Methods: In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg... (More)

Background: Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI. Methods: In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg and smoking abstinence. Results: The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78–2.50]; 2.45 [1.91–2.99]), having a psychologist in the CR team (1.62 [1.36–1.87]; 2.05 [1.67–2.44]), extended opening hours (2.13 [2.00–2.27]; 1.50 [0.91–2.10]), adequate facilities (1.54 [0.91–2.18]; 1.89 [1.38–2.40]), and having a medical director (1.70 [0.91–2.48]; 1.46 [1.04–1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39–4.51]) and having no history of hypertension (2.93 [2.60–3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66–2.10]; 1.46 [1.14–1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95–2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07–2.88]) and group education (1.92 [1.43–2-42]), and no cardiovascular disease history (2.13 [1.78–2.48]). Conclusions: We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac rehabilitation, Myocardial infarction, Predictors, Risk factors
in
International Journal of Cardiology
volume
371
pages
40 - 48
publisher
Elsevier
external identifiers
  • scopus:85138091369
  • pmid:36089158
ISSN
0167-5273
DOI
10.1016/j.ijcard.2022.09.012
language
English
LU publication?
yes
id
cea09bd9-4d73-4b62-b90f-f0a0c32a3b49
date added to LUP
2022-12-05 10:55:00
date last changed
2024-09-21 05:21:00
@article{cea09bd9-4d73-4b62-b90f-f0a0c32a3b49,
  abstract     = {{<p>Background: Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI. Methods: In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values &gt;0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) &lt;1.8 mmol/L, blood pressure (BP) &lt;140/90 mmHg and smoking abstinence. Results: The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78–2.50]; 2.45 [1.91–2.99]), having a psychologist in the CR team (1.62 [1.36–1.87]; 2.05 [1.67–2.44]), extended opening hours (2.13 [2.00–2.27]; 1.50 [0.91–2.10]), adequate facilities (1.54 [0.91–2.18]; 1.89 [1.38–2.40]), and having a medical director (1.70 [0.91–2.48]; 1.46 [1.04–1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39–4.51]) and having no history of hypertension (2.93 [2.60–3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66–2.10]; 1.46 [1.14–1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95–2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07–2.88]) and group education (1.92 [1.43–2-42]), and no cardiovascular disease history (2.13 [1.78–2.48]). Conclusions: We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.</p>}},
  author       = {{Michelsen, Halldora Ögmundsdottir and Henriksson, Peter and Wallert, John and Bäck, Maria and Sjölin, Ingela and Schlyter, Mona and Hagström, Emil and Kiessling, Anna and Held, Claes and Hag, Emma and Nilsson, Lennart and Schiopu, Alexandru and Zaman, M. Justin and Leosdottir, Margret}},
  issn         = {{0167-5273}},
  keywords     = {{Cardiac rehabilitation; Myocardial infarction; Predictors; Risk factors}},
  language     = {{eng}},
  pages        = {{40--48}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Cardiology}},
  title        = {{Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction : The Perfect-CR study}},
  url          = {{http://dx.doi.org/10.1016/j.ijcard.2022.09.012}},
  doi          = {{10.1016/j.ijcard.2022.09.012}},
  volume       = {{371}},
  year         = {{2023}},
}