Cardiac Rehabilitation Engagement and Predictive factors in Heart Failure patients: A cross-sectional study
Authors: Yu Tianxi , Gao Min , Sun Guozhen , Graffigna Guendalina , Liu Shenxinyu , Wang Jie 
Published: May 2023

Abstract
Background: Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation was suboptimal, a frequently low engagement in rehabilitation programs has been found globally.
Objective: To quantify diverse CR-engaged processes and elucidate predictors of the various levels of CR engagement in CHF patients.
Methods: CHF patients admitted or discharged from cardiology departments between May 1 2022 to November 1 2022 were enrolled. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®) We obtained sociodemographic characteristics and clinical data from medical records. The survey was distributed via mobile phone text messaging or face-to-face completed. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases.
Results: A total of 684 patients were included in the study. Univariate analysis showed that only kinesiophobia had no correlation with engagement phases besides socio-demographic and clinical variables. Multivariate logistic regression analysis revealed that compared with the blackout phaseprocess anxiety (Arousal: OR 0.829, 95%CI: 0.73 ~ 0.94; Adhesion: OR 0.725, 95%CI: 0.64 ~ 0.82; Eudaimonic Project: OR 0.674, 95%CI: 0.59 ~ 0.77), monthly income (RMB yuan) equal to or more than 5,000 (Arousal: OR 6.342, 95%CI: 1.30 ~ 31.01; Adhesion: OR 5.226, 95%CI: 1.09 ~ 24.96; Eudaimonic Project: OR 6.658, 95%CI 1.26 ~ 34.76) were the most important factor impacting CHF patients CR engagement. In the Arousal phase, versus the Blackout phase, regular exercise or not (OR 3.29, 95% CI: 1.19 ~ 9.10), severe depression (OR 0.019, 95% CI: 0.00 ~ 0.813), previous cardiac-related hospitalizations 1 or 2 times (OR 3.75, 95% CI: 1.19 ~ 11.86), Age (OR 0.958, 95% CI: 0.92 ~ 0.998) influenced patient CR engagement. Besides, compared to the Blackout phase, outcome anxiety (OR 1.269, 95% CI: 1.11 ~ 1.46) and activation level (level 2: OR 9.357, 95% CI: 1.44 ~ 60.68; level 3: OR 29.96, 95% CI: 3.67 ~ 244.92; level 4: OR 29.71, 95% CI: 3.62 ~ 243.61) were independent factors predicting the Eudaimonic Project phase.
Conclusions: This study characterized CR engagement, and explored demographic, medical, and psychological factors— with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The predictor factors of CR engagement were not identical among different phases which strongly indicates a significant role in quantifying CR engagement. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.