Association of Perceived Health Competence With Cardiac Rehabilitation Initiation

Abstract

Purpose: Cardiac rehabilitation (CR), a program of supervised exercise and cardiovascular risk management, is widely underutilized. Psychological factors such as perceived health competence, or belief in one's ability to achieve health-related goals, may play a role in CR initiation. The aim of this study was to evaluate the association of perceived health competence with CR initiation among patients hospitalized for acute coronary syndrome (ACS) after adjusting for demographic, clinical, and psychosocial characteristics.

Methods: The Vanderbilt Inpatient Cohort Study (VICS) characterized the effect of psychosocial characteristics on post-discharge outcomes in ACS inpatients hospitalized from 2011 to 2015. The primary outcome for this analysis was participation in an outpatient CR program. The primary predictor was the two-item Perceived Health Competence Scale (PHCS-2), which yields a score from 2 to 10 (higher scores indicate greater perceived health competence). Multiple logistic regression was used to evaluate the relationship between the PHCS-2 and CR initiation.

Results: A total of 1809 VICS participants (median age: 61 yr, 39% female) with ACS were studied, of whom 294 (16%) initiated CR. The PHCS-2 was associated with a higher odds of CR initiation (OR = 1.15/point increase: 95% CI, 1.06-1.26, P = .001) after adjusting for covariates. Participants with comorbid heart failure had a lower odds of CR initiation (OR = 0.31: 95% CI, 0.16-0.60, P < .001) as did current smokers (OR = 0.64: 95% CI, 0.43-0.96, P = .030).

Conclusion: Perceived health competence is associated with outpatient CR initiation in patients hospitalized with ACS. Interventions designed to support perceived health competence may be useful for improving CR participation.

Figure 1:

Flow diagram for study participants (N=1809).

Figure 2:

Distribution of two-item perceived health competence scale (PHCS-2) scores in the Vanderbilt Inpatient Cohort Study (N=1809).

Figure 3:

Model-estimated relationship of perceived health competence with probability of cardiac rehabilitation initiation in patients hospitalized with acute coronary syndrome (N=1809). Shaded areas represent 95% confidence intervals. The model was adjusted for age, sex, education, income, home status, insurance status, heart failure, body mass index, diabetes, length of stay during the index hospitalization, and psychosocial instruments including the ARMS-7, BHLS, BRCS, ESSI-6, HCSD, modified PROMIS Global-10, PHQ-8, SNS and SPMSQ.