Those who are more ill more often refuse help to get healthier: the cardiac rehabilitation acceptance paradox
Abstract
Introduction. Coronary heart disease is the leading cause of death in industrialised countries. Cardiac rehabilitation allows improvement of functioning after acute coronary syndrome (ACS). It is important to identify the factors that have an impact upon treatment and rehabilitation decisions. We aimed to assess the impact of the clinical characteristics of ACS pts upon the decision to participate in an early inpatient cardiac rehabilitation programme (ICR).
Material and methods. 137 patients after ACS (70% ST-elevation myocardial infarction) treated with primary percutaneous coronary angioplasty were enrolled in the study. Quality of life questionnaire (EuroQol-5D with Visual Analogue Scale) and depression score (Beck Depression Inventory) was collected at discharge from cardiology department (5 ± 2 days after ACS). All patients were asked to participate in a three-week-long ICR programme. Depending on approval or refusal, the patients were divided into two subgroups.
Results. The group without ICR had lower median values of red blood count, haemoglobin and haematocrit compared to the rehabilitation group. The objectors had higher total cholesterol, low-density lipoproteins cholesterol, and Gensini score (40 ± 22.6 vs. 35 ± 24.3, p = 0.02). There was a strong trend towards a lower median depression level in the ICR group compared to controls (8 ± 8.8 vs. 12 ± 8.5, p = 0.06). No other statistically significant differences were identified between the groups.
Conclusions. Patients who refuse cardiac rehabilitation had a worse clinical profile compared to those who accepted ICR. A higher depression score was a borderline significant predictor of refusing ICR. Paradoxically, sicker patients are less willing to take part in rehabilitation and require more encouragement as part of their individualised treatment.
Keywords: resignationparadoxcardiac rehabilitation
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