Abstract
Objective
Few studies have examined the correlates of real-world cardiac rehabilitation (CR)
effectiveness. The objective of this study was to determine the relationship between
baseline risk, behavioral attrition, and the number needed to treat (NNT) associated
with CR.
Study Design and Setting
A retrospective study was conducted among 16,061 CR patients between 1995 and 2011
in Canada. Multiple logistic regression models were derived from patient characteristics
and measured baseline risk (individual's risk of death within 3 years) and behavioral
attrition (individual's risk of premature dropout). We examined the treatment efficacy
of CR among nondropouts using a 20% relative risk reduction. Further sensitivity analyses
were performed to assess the robustness of our assumptions. We assumed no efficacy
among dropouts.
Results
Both baseline risk and behavioral attrition were independently associated with NNT,
although baseline risk had a stronger association with NNT than behavioral attrition.
Increasing age, lower baseline fitness, history of diabetes, hypertension, and greater
comorbidities were associated with lower NNT. Being female, living alone, living in
the lowest neighborhood income quintile, and greater adiposity were associated with
higher NNT.
Conclusion
The clinical effectiveness of CR is largely driven by the baseline risk rather than
the behavioral attrition of the populations they serve. These findings have implications
for risk stratification among those with greatest survival yields and programmatic
needs.
Keywords
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Article info
Publication history
Published online: April 28, 2016
Accepted:
March 11,
2016
Footnotes
Conflict of interest: The authors have no conflicts of interest to disclose.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. D.A.A. is supported with a Career Investigator Award from the Heart and Stroke Foundation of Canada. G.E.F. is supported with a Canadian Institutes of Health Research-Public Health Agency of Canada (CIHR-PHAC) Chair in Applied Public Health. P.I.O. is supported with a GoodLife Fitness Chair in Cardiovascular Rehabilitation and Prevention, University Health Network-Toronto Rehabilitation Institute, University of Toronto.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
