title: Comorbidities and Psychosocial Characteristics as Determinants of Dropout in Outpatient Cardiac Rehabilitation.
abstract: BACKGROUND
  Despite the clear benefits of cardiac rehabilitation (CR), a considerable number of patients drop out early.
  
  
  OBJECTIVE
  Therefore, we wanted to evaluate dropout in CR with a special focus on comorbidities and psychosocial background.
  
  
  METHODS
  Patients who attended CR after acute coronary syndrome, cardiac surgery, or heart failure (N = 489) were prospectively included. Dropout was defined as attending 50% of the training sessions or less (n = 96 [20%]). Demographic and clinical characteristics, exercise parameters, and psychosocial factors were analyzed according to dropout, and those with a trend toward a significant difference (P < .10) were entered in a multivariate logistic model.
  
  
  RESULTS
  The presence of a cerebrovascular accident (4.18 [1.39-12.52]) involved a higher risk of dropout, and a comparable trend was seen for the presence of chronic obstructive pulmonary disease (2.55 [0.99-6.54]). Attending the training program only twice per week also implicated a higher risk of an early withdrawal (3.76 [2.23-6.35]). In contrast, patients on β-blockers were less likely to withdraw prematurely (0.47 [0.22-0.98]). Singles were more likely to drop out (2.89 [1.56-5.35]), as well as those patients who were dependent on others to get to CR (2.01 [1.16-3.47]). Finally, the reporting of severe problems on the anxiety/depression subscale of the EuroQOL-5D questionnaire involved a higher odds for dropout (7.17 [1.46-35.29]).
  
  
  CONCLUSIONS
  Neither demographic characteristics nor clinical status or exercise capacity could independently identify patients who were at risk of dropout. The presence of comorbidities and a vulnerable psychosocial background rather seem to play a key role in dropout.
authors.affiliation: Sofie Pardaens, PhD PhD student, Department of Internal Medicine at Ghent University, Belgium. Dr Pardaens is now a scientific coworker at OLV Hospital in Aalst, Belgium. Delphine De Smedt, PhD FWO Postdoctoral Fellow, Department of Public Health, Ghent University, Belgium. Dirk De Bacquer, PhD Professor and Head, Department of Public Health, Ghent University, Belgium. Anne-Marie Willems, PhD Scientific Coordinator, Department of Cardiology, AZ Maria Middelares, Ghent, Belgium. Sofie Verstreken, MD Cardiologist, Cardiovascular Center, Onze-Lieve-Vrouw Hospital, Aalst, Belgium. Johan De Sutter, MD, PhD Professor, Department of Internal Medicine, Ghent University; and Cardiologist, Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Pardaens
authors.forename: Delphine
authors.initials: D
authors.lastname: De Smedt
authors.forename: Dirk
authors.initials: D
authors.lastname: De Bacquer
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Willems
authors.forename: Sofie
authors.initials: S
authors.lastname: Verstreken
authors.forename: Johan
authors.initials: J
authors.lastname: De Sutter
mesh_terms: D000328:Adult; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000523:psychology / Q000706:statistics & numerical data*; D015897:Comorbidity; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies