Brouwers Rutger Willem Maurice, Brini Alberto, Kuijpers Robin Wilhelmus Franciscus Henricus, Kraal Jozua Johannes, Kemps Hareld Marijn Clemens
Department of Cardiology, Máxima Medical Center, De Run 4600, Postbus 7777, 5500 MB Veldhoven, The Netherlands.
Vitality Center, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands.
Eur Heart J Digit Health. 2021 Dec 10;3(1):81-89. doi: 10.1093/ehjdh/ztab105. eCollection 2022 Mar.
Current cardiac telerehabilitation (CTR) interventions are insufficiently tailored to the preferences and competences of individual patients, which raises the question whether their implementation will increase overall participation and adherence to cardiac rehabilitation (CR). However, research on patient-specific factors that influence participation and adoption of CTR interventions is scarce. The aim of this study was to evaluate which patient-related characteristics influence participation in a novel CTR intervention in patients with coronary artery disease.
This prospective observational substudy of the SmartCare-CAD randomized controlled trial evaluated patient characteristics of study participants as proxy for participation in a CTR intervention. We compared demographic, geographic, and health-related characteristics between trial participants and non-participants to determine which characteristics influenced trial participation. A total of 699 patients (300 participants and 399 non-participants; 84% male, mean age 64.3 ± 10.5 years) were included. Most of the non-participants refused participation because of insufficient technical skills or lack of interest in digital health (26%), or preferred centre-based CR (21%). Variables independently associated with non-participation included: higher age, lower educational level, shorter travelling distance, smoking, positive family history for cardiovascular disease, having undergone coronary artery bypass grafting; and a higher blood pressure, worse exercise capacity, and higher risk of depression before the start of CR.
Participation in CTR is strongly influenced by demographic and health-related factors such as age, educational level, smoking status, and both physical and mental functioning. Cardiac telerehabilitation interventions should therefore be redesigned with the involvement of these currently underrepresented patient subgroups.
当前的心脏远程康复（CTR）干预措施未能充分根据个体患者的偏好和能力进行调整，这引发了一个问题，即其实施是否会提高心脏康复（CR）的总体参与度和依从性。然而，关于影响CTR干预措施参与度和采用率的患者特定因素的研究却很少。本研究的目的是评估哪些患者相关特征会影响冠心病患者参与新型CTR干预。
这项对SmartCare-CAD随机对照试验的前瞻性观察性子研究评估了研究参与者的患者特征，以此作为参与CTR干预的代表。我们比较了试验参与者和非参与者之间的人口统计学、地理和健康相关特征，以确定哪些特征影响了试验参与度。总共纳入了699名患者（300名参与者和399名非参与者；84%为男性，平均年龄64.3±10.5岁）。大多数非参与者拒绝参与是因为技术技能不足或对数字健康缺乏兴趣（26%），或者更喜欢基于中心的CR（21%）。与不参与独立相关的变量包括：年龄较大、教育水平较低、出行距离较短、吸烟、有心血管疾病家族史、接受过冠状动脉搭桥手术；以及在CR开始前血压较高、运动能力较差和抑郁风险较高。
CTR的参与度受到年龄、教育水平、吸烟状况以及身体和心理功能等人口统计学和健康相关因素的强烈影响。因此，心脏远程康复干预措施应在这些目前代表性不足的患者亚组的参与下重新设计。
