title: Why patients after acute coronary syndromes do not participate in an early outpatient rehabilitation programme?
abstract: BACKGROUND
  The value of cardiac rehabilitation in patients with coronary artery disease has been well established. The main problem is a low attendance of patients qualified for rehabilitation.
  
  
  OBJECTIVE
  To assess differences between subjects attending outpatient cardiac rehabilitation (OutCR) after completing an early inpatient programme (InCR), and patients refusing participation in OutCR; to investigate factors determining patients' decisions.
  
  
  METHODS
  Seventy-two patients (mean age 57 +/- 9.4 years; 53 men) 2-3 weeks after an acute coronary syndrome (ACS) treated with primary PCI were enrolled. On admission to the cardiac rehabilitation ward, the following parameters were assessed: quality of life (EuroQol-5D questionnaire), psychological status (Beck's, SOPER and STAI questionnaires), marital status, education, economic status, employment, place of living, smoking status, and comorbidities (a questionnaire prepared by the authors). Additionally, patients' opinions on outpatient and inpatient cardiac rehabilitation were noted. The inpatient programme lasted 2-3 weeks. At discharge, the assessment was repeated, and patients were proposed to enrol in a 12-week outpatient programme. In the case of refusal, patients were asked to give the reason.
  
  
  RESULTS
  Two men failed to complete the inpatient program. Of the remaining 70 subjects, 16 attended and completed the outpatient programme. In the group participating in OutCR, there were fewer patients with depression before InCR (12 vs. 39% in the group without OutCR, p = 0.0484). Subjects in the OutCR group had a higher score for mood after InCR (7.7 +/- 1.25 vs. 6.7 +/- 1.69, p = 0.0365), lower score for emotional stress before and after InCR (before InCR: 4.4 +/- 1.09 vs. 5.3 +/- 1.34, p = 0.0188; after InCR: 3.8 +/- 1.51 vs. 4.8 +/- 1.4, p = 0.0262), and lower score for anxiety before InCR (3.1 +/- 1.75 vs. 4.4 +/- 2.12, p = 0.0426). Patients in the two groups differed with regard to employment (p = 0.0256) and smoking status (p = 0.0517). In both groups, most patients (ł 80%) preferred inpatient rehabilitation. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation.
  
  
  CONCLUSIONS
  Only a small proportion of patients after an ACS decides to participate in outpatient rehabilitation after completing a short-term inpatient programme. Psychological status, employment and smoking status are among the factors that differentiate OutCR attenders and non-attenders. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation.
authors.affiliation: Akademia Wychowania Fizycznego, ul. Królowej Jadwigi 27/39, 61-871 Poznań, Poland. edeskur@poczta.onet.pl
authors.forename: Ewa
authors.initials: E
authors.lastname: Deskur-Smielecka
authors.forename: Sławomira
authors.initials: S
authors.lastname: Borowicz-Bieńkowska
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Brychcy
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Wilk
authors.forename: Izabela
authors.initials: I
authors.lastname: Przywarska
authors.forename: Piotr
authors.initials: P
authors.lastname: Dylewicz
mesh_terms: D054058:Acute Coronary Syndrome / Q000534:rehabilitation*; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011044:Poland; D011159:Population Surveillance; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data