Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe

Beate Zoch-Lesniak; Jeanette Dobberke; Axel Schlitt; Christa Bongarth; Johannes Glatz; Sieglinde Spörl-Dönch; Iryna Koran; Heinz Völler; Annett Salzwedel

doi:10.1016/j.arrct.2020.100043

Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe

Arch Rehabil Res Clin Transl. 2020 Jan 24;2(2):100043. doi: 10.1016/j.arrct.2020.100043. eCollection 2020 Jun.

Authors

Beate Zoch-Lesniak¹, Jeanette Dobberke¹, Axel Schlitt², Christa Bongarth³, Johannes Glatz⁴, Sieglinde Spörl-Dönch⁵, Iryna Koran⁶, Heinz Völler^{1

6}, Annett Salzwedel¹

Affiliations

¹ Department of Rehabilitation Research, University of Potsdam, Germany.
² Paracelsus-Harz-Klinik, Rehabilitation Center of Cardiovascular Diseases, Quedlinburg, Germany.
³ Klinik Höhenried, Bernried, Germany.
⁴ Reha-Klinik Seehof der Deutschen Rentenversicherung Bund, Teltow, Germany.
⁵ Frankenklinik, Bad Neustadt/Saale, Germany.
⁶ Klinik am See, Rehabilitation Center of Cardiovascular Diseases, Rüdersdorf, Germany.

Abstract

Objective: To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality.

Design: Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany.

Setting: Comprehensive 3-week CR.

Participants: Patients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018).

Interventions: Not applicable.

Main outcome measures: Feasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA).

Results: Based on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure.

Conclusions: We provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.

Keywords: 6MWD, 6-minute walking distance; 95% CI, 95% confidence interval; ACS, acute coronary syndrome; BMI, body mass index; CR, cardiac rehabilitation; Cardiac rehabilitation; Cardiovascular diseases; EDC, electronic data capture; HAF-17, Herzangstfragebogen (German version of the Cardiac Anxiety Questionnaire); IRES-24, indicators of rehabilitation status-24; KMO, Kaiser-Meyer-Olkin; LDL, low-density lipoprotein; OutCaRe, Outcome of Cardiac Rehabilitation; Outcome measures; PAD, peripheral artery disease; PCS, physical component summary; PHQ-9, Patient Health Questionnaire-9; Quality indicators; Rehabilitation; Rehabilitation outcome; SES, standardized effect size; SF-12, Medical Outcomes Study 12-Item Short-Form Health Survey; Secondary prevention; WHO-5, 5-item World Health Organization Well-Being Index; health care.