Association between functional impairments at hospital discharge and short-term barriers to cardiac rehabilitation in acute coronary syndrome: a longitudinal study
Associação entre déficits funcionais na alta hospitalar e barreiras de curto prazo à reabilitação cardíaca na síndrome coronariana aguda: um estudo longitudinal
Gabriel Parisotto, Maurício Sant’Anna Junior, Jannis Papathanasiou, Luis Felipe da Fonseca Reis, Arthur de Sá Ferreira
Abstract
Background: The functional status of acute coronary syndrome (ACS) patients at hospital discharge and its impact on participation in cardiac rehabilitation (CR) programs remains unclear. Aim: This study investigates barriers to and adherence in CR programs 30 days post-discharge for ACS exacerbation and explores the predictive value of functional characteristics for these barriers. Methods: Upon hospital discharge, participants underwent functional tests, including assessments of respiratory muscle strength (maximal inspiratory and expiratory pressures [MIP and MEP]), handgrip strength (HGS), and the 6-minute walk distance (6MWD). Thirty days post-discharge, participants were evaluated using the Cardiac Rehabilitation Barrier Scale (CRBS). Results: 130 participants (64.6% men, mean age 65 ± 12 years, median length of stay before discharge 17 [8; 41] days) were included. The major barrier to participation and adherence in CR programs was comorbidities/functional status (13.1 ± 4.3 points). After adjustment for age, sex, and length of stay, the CRBS comorbidities/ functional score was negatively associated with MIP (β= -0.123, 95% CI -0.215 to -0.031), while the CRBS perceived needs/healthcare factors score was positively associated with MIP (β= 0.073, 95% CI 0.009 to 0.137). Conclusion: Barriers to participation and adherence in CR programs among ACS adults 30 days post-hospital discharge are mainly explained by respiratory muscle function. These findings underscore the importance of early post-discharge strategies targeting patients with lower functional status to reduce barriers to CR participation.
Keywords
Resumo
Introdução: O estado funcional dos pacientes com síndrome coronariana aguda (SCA) na alta hospitalar e seu impacto na participação em programas de reabilitação cardíaca (RC) permanece desconhecidos. Objetivo: Investigar barreiras e adesão em programas de RC 30 dias pós-alta por exacerbação de SCA e explorar o valor preditivo das características funcionais para essas barreiras. Métodos: Na alta hospitalar, os participantes foram submetidos a testes de capacidade funcional, força muscular respiratória (pressões inspiratórias e expiratórias máximas [PImáx e PEmáx]), força de preensão manual (FPM) e distância percorrida no teste de caminhada de 6 minutos (DTC6). Trinta dias após a alta, os participantes foram avaliados por meio da Escala de Barreira de Reabilitação Cardíaca (CRBS). Resultados: Foram incluídos 130 participantes (64,6% homens, idade média 65 ± 12 anos, tempo mediano de internamento antes da alta 17 [8; 41] dias). A principal barreira foi comorbidades/estado funcional (13,1 ± 4,3 pontos). Após ajuste para idade, sexo e tempo de internação, o escore de comorbidades/funcional do CRBS foi negativamente associado à PImáx (β= -0,123, IC 95% -0,215 a -0,031), enquanto o escore de necessidades percebidas/fatores de saúde do CRBS foi positivamente associado com PImáx (β= 0,073, IC 95% 0,009 a 0,137). Conclusão: As barreiras à participação e adesão em programas de RC entre adultos com SCA 30 dias pós-alta hospitalar são explicadas principalmente pela função muscular respiratória. Esses achados ressaltam a importância de estratégias precoces pós-alta direcionadas a pacientes com status funcional mais baixo para reduzir barreiras à participação na RC.
DOI da versão traduzida: https://doi.org/10.47066/2966-4837.2024.0008pt
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Submetido em:
16/10/2024
Aceito em:
02/01/2025
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