Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal

Author:

Alexandre André12ORCID,Schmidt Cristine345ORCID,Campinas Andreia12ORCID,Gomes Catarina12,Magalhães Sandra25678,Preza-Fernandes José16,Torres Severo12,Santos Mário12568

Affiliation:

1. Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal

2. ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal

3. Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal

4. CIAFEL—Physical Activity, Health and Leisure Research Centre, Faculty of Sports, University of Porto, 4200-450 Porto, Portugal

5. ITR—Laboratory for Integrative and Translational Research in Population Health, 4050-600 Porto, Portugal

6. Unit of Cardiovascular Prevention and Rehabilitation, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal

7. Department of Physical and Rehabilitation Medicine, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal

8. UMIB—Unit for Multidisciplinary Research in Biomedicine, ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal

Abstract

Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p < 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p < 0.01). Patients enrolled in CR were more likely to be treated with sacubitril/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p < 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1.04; 95% CI 1.01–1.07), higher education level (adjusted OR 3.31; 95% CI 1.63–6.70), stroke (adjusted OR 3.29; 95% CI 1.06–10.27), COPD (adjusted OR 4.82; 95% CI 1.53–15.16), and no ICD status (adjusted OR 2.68; 95% CI 1.36–5.26) were independently associated with CR non-enrollment. The main reasons for not being enrolled in CR were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Despite the relatively high proportion (35%) of HFrEF patients who underwent CR, the enrollment rate can be further improved. Innovative multi-level strategies addressing physicians’ awareness, patients’ comorbidities, and geographical issues should be pursued.

Funder

FEDER, through COMPETE2020-POCI

national funds through Fundação para a Ciência e Tecnologia, I.P. [FCT/MCTES]

national funds through Fundação para a Ciência e Tecnologia, I.P.

Publisher

MDPI AG

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