Study Details Factors Associated with Nonparticipation in Telerehabilitation Programs for Cardiovascular Conditions

Rutger Brouwers, MD, PhD

A recent study from investigators in the Netherlands provides insight into predictors of nonparticipation for patients with cardiovascular conditions enrolled in a telerehabilitation program.

A prospective analysis of nearly 700 patients, the results of the study demonstrate insufficient skills or lack of interest in digital health and a preference for medical center-based rehabilitation were the primary drivers of nonparticipation among patients, with results also providing insight into patient characteristics associated with increased likelihood of nonparticipation.

“Increasing the overall use of cardiac rehabilitation programs is a major challenge. In order to exploit cardiac telerehabilitation’s potential to increase overall cardiac rehabilitation participation rates, current cardiac telerehabilitation interventions should be tailored to appeal to elderly patients and patients with lower educational levels, lower digital literacy, lower exercise capacity, and patients who underwent CABG,” wrote investigators.

As the COVID-19 pandemic has transformed the role of telehealth from science fiction to reality for many, the research spotlight on the utility of telehealth and telehealth-based programs has ballooned. Led by Rutger Brouwers, MD, PhD, the current study was designed as a substudy of the prospective SmartCare-CAD trial, which is a randomized controlled trial evaluation patient characteristics of participants as a proxy for participation in a cardiac telerehabilitation program. The intent of the prospective, observational substudy was to evaluate and compared demographic, geographic, and health-related characteristics among participants and nonparticipants.

As part of the recruitment process for the SmartCare-CAD trial, patients considered eligible were verbally informed about the procedures by their rehabilitation coordinator during the intake procedure. If a patient refused to participate in the trial, they were entered into a standard, medical center-based cardiac rehabilitation program. These patients were informed of the substudy and asked to provide written informed consent for the registration of the reason for refusal in the substudy.

A total of 300 patients were included in the SmartCare-CAD trial and 399 declined participation but provided informed consent to be registered in the substudy. Of the 699 included in the study, 84% were male and the mean age of the cohort was 64.3±10.5 years. Investigators noted 71% of patients were referred for rehabilitation because of an acute coronary syndrome and 91% had undergone coronary revascularization prior to enrollment in cardiac rehabilitation.

Among patients who declined participation, 26% cited insufficient technical skills or lack of interest in digital health, 21% cited a preference for center-based cardiac rehabilitation, 13% cited trial participation being too burdensome, 7% cited not being convinced of the added value of telerehabilitation, and 6% cited lack of time. Compared to those who participated, nonparticipants were significantly older (67.0 vs 60.7 years; P < .001), more often female (20.3% vs 11.3%; P=.002), less often employed (28.0% vs 60.0%, P <.001), and were less often highly educated (24.2% vs 50.3%; P <.001).

In multivariable logistic regression analysis, higher age, lower educational level, shorter traveling distance to the nearest hospital, smoking, no previously diagnosed hypertension, positive family history for CVD, having undergone CABG, higher blood pressure, worse exercise capacity, higher risk of depression, and better quality of life were all variables associated with increased likelihood of nonparticipation.

“In order to increase cardiac telerehabilitation use in daily practice and to improve health equity through digital innovations, cardiac telerehabilitation interventions should be redesigned taking into account the needs and competencies of a wide spectrum of cardiovascular patients, especially subgroups that are underrepresented in current center-based cardiac rehabilitation and cardiac telerehabilitation interventions,” investigators added.

This study, “Predictors of non-participation in a cardiac telerehabilitation programme: a prospective analysis,” was published in the European Heart Journal - Digital Health.