Cardiac rehabilitation: post-discharge barriers and functional predictors of hospital readmission due to exacerbation in acute coronary syndrome

Abstract

Introduction: The functional status of patients with Acute Coronary Syndrome (ACS) at hospital discharge and its impact on hospital readmission are still unclear. Objective: This study investigates the predictive power of functional characteristics and the Barriers to
Cardiac Rehabilitation Scale (CBRS) with hospital readmission 30 days after hospital discharge in patients with ACS, and also explores the predictive power of functional characteristics with the CBRS 30 days after hospitalization for ACS exacerbation. Methods: A two-stage study was carried out: a cross-sectional analysis with 130 participants and a longitudinal analysis with 320 participants. At hospital discharge, participants underwent functional capacity tests to assess respiratory muscle strength (MIP and MEP), handgrip strength (HGS) and the distance covered in the 6-minute walk test (6MWT). Thirty days after hospital discharge, the participants answered the EBRC, divided into four domains: perceived needs/health care factors, logistical factors, work/time conflicts and comorbidities/functional status. At the same time, they were assessed as to the occurrence of hospital readmission. Results: In the crosssectional study, an association was observed between EBRC with functional characteristics. After adjusting for age, gender, body mass index, GRACE score and length of stay, the CRBS comorbidities/functionality score was inversely associated with MIP (OR = -0.123, 95%CI -0.215 to -0.031). In addition, the CRBS perceived needs/health factors score was associated with MIP (OR = 0.073, 95%CI 0.009 to 0.137). In the longitudinal study, functional predictors and CRBS were risk factors for hospital readmission. After adjusting for age, gender, body mass index, GRACE score, length of stay and time after hospital discharge, the 6MWT (OR = 0.981, 95%CI 0.968 to 0.994, p = 0.005), MEP (OR = 0, 891, 95%CI 0.841 to 0.945, p < 0.001) and EBRC comorbidity/functional status score (OR = 1.429, 95%CI 1.241 to 1.645, p < 0.001) were risk factors for hospital readmission. The 6MWT was also associated with the sum of the EBRC score (OR = - 0.020, 95%CI -0.034 to -0.006, p = 0.005). Conclusion: Our study highlights functional status both as a predictor for readmission and as a factor associated with barriers to CR in ACS patients within 30 days of hospital discharge. These results underline the importance of early identification of functional deficits and barriers to cardiac rehabilitation.