Following an acute myocardial infarction (AMI), survivors aged >45 years were more likely to join an outpatient cardiac rehabilitation programme (CRP) in Singapore if they were nonsmokers, but the opposite is true for younger survivors (aged <45 years), according to a study presented at SPCRS 2017.

“Outpatient CRP has been strongly recommended for patients post-AMI for its association in reducing mortality and re-admission rates,” wrote the researchers led by Cao Yan, a senior nurse clinician based in Changi General Hospital, Singapore. “[Despite the] importance of CRP in clinical setting, its enrolment rate remains low for eligible patients.”

The prospective single-centred study included 245 eligible patients (mean age 56 years, 85.3 percent males) admitted to an acute care hospital in Singapore with a confirmed diagnosis of STEMI* (45.7 percent) or NSTEMI** (45.7 percent). They were offered to join an outpatient CRP, which defines enrolment eligibility as full revascularization or as adjudicated by their cardiologists upon discharge.

Of the eligible patients, only 59 (24.1 percent) agreed to join the CRP. [SPCRS 2017, abstract N-11]

For patients aged >45 years, those who also did not smoke were more likely to join the programme than smokers (p=0.017); while smokers are more likely to join among younger patients aged <45 years (p=0.002).

Also, patients free from the common comorbidities of hypertension, diabetes mellitus, and hyperlipidaemia were more likely to join the programme.

Race, gender, diagnosis, and having primary percutaneous coronary interventions were not significant predictors of enrolment in the CRP.

The most common reasons given for not joining the programme were patient’s perception that they could exercise on their own (29 percent) and work commitment (23.1 percent). Twenty-two percent of the non-enrolled patients were undecided, while financial constraints were cited as reason in 13.0 percent of the non-enrolled patients.

“Targeted strategies to counter financial constraints and postdischarge follow-up on CRP enrolment have been implemented to address the various needs of the patients,” according to Cao and co-authors. “[The study suggests] tailoring patient education based on smoker by age or patients with [the] three comorbidities (hypertension, diabetes mellitus, and hyperlipidaemia) to improve CRP enrolment.”

They also suggested strategies such as individual home-based or telehealth CRP to increase future enrolment rate to the programme.

“The findings could be used for re-examining the standard patient education and strategies used by the clinical team for outpatient CRP with a view of improving patient’s outcomes,” Cao and co-authors concluded.