DIABETIC CORONARY HEART PATIENTS' ADHERENCE TO CARDIAC REHABILITATION PROGRAMS

Background: Enrollment in cardiac rehabilitation programs (CR) is used to help patients with coronary artery disease alone (CAD) and diabetes mellitus plus coronary artery disease (T2DM+CAD) regain function after coronary artery bypass grafting (CABG), but T2DM+CAD patients show less functional improvement and lower CR adherence for unknown reasons. The "Patient-by-Treatment Context Interaction in Disease Model" may provide a framework for explaining how disease and intrapersonal factors impact outcomes of these patients. Objective: To explore potential differences in patient profiles and illness contextual factors between CAD and T2DM+CAD subjects at CR entry, and in adherence and outcomes at CR conclusion.Methods: This prospective descriptive pilot study recruited 51 CR subjects (27 CAD; 24 T2DM+CAD) and measured patient profiles (socio-demographics, personality traits, locus of control, coping, social support, exercise efficacy) and illness contextual factors (specific disease stage, illness severity, treatment complexity, comorbidities) at CR entry, and appointment and medication adherence, functional status and illness severity at CR conclusion, using questionnaires, point-of-care testing, and medical record information.Results: There were no statistically significant differences in patient profiles and illness contextual factors between the CAD and T2DM+CAD cohorts, but there were clinically meaningful trends regarding age and gender (T2DM+CAD younger and more female), profiles (CAD more conscientious; T2DM+CAD more adaptive coping, less exercise efficacy) and illness severity (T2DM+CAD fewer bypasses but lower ejection fraction, many CAD subjects were pre-diabetic). There were no statistically significant differences between cohorts in attendance, medication adherence and functional outcomes at CR conclusion, but the T2DM+CAD cohort reported need for more functional assistance at both time points; neither cohort improved their illness severity. Conclusions: Although patient profiles and illness contextual factors of CAD and T2DM+CAD subjects in a CR program were statistically similar, some clinically meaningful trends were noted that are worthy of future investigation to inform CR care