Key result
Cardiac rehabilitation organizational factors, including psychosocial management and nurse medication protocols, strongly predicted risk factor target attainment 1-year post-MI (VIP > 0.8).
Why the study?
How individual components of cardiac rehabilitation programmes predict attainment of risk factor targets after MI, and their predictive strength relative to patient characteristics, remained unclear.
What organizational and patient-level factors predict the attainment of risk factor targets at 1-year post-myocardial infarction?
Observational (n=6,755)
Yes
What organizational and patient-level factors predict the attainment of risk factor targets at 1-year post-myocardial infarction?
Specific organizational features of cardiac rehabilitation programs, such as psychosocial management and nurse-led medication adjustment, strongly predict patient attainment of secondary prevention targets post-MI.
Emphasizes enhancing nurse continuity and psychosocial support in rehab; extends RCT evidence on multilevel predictors of post-MI target attainment.
Aims How individual components of cardiac rehabilitation (CR) programmes predict attainment of risk factor targets after myocardial infarction (MI), and their predictive strength relative to patient characteristics, remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at 1-year post-MI. Methods and results Organizational structure and processes followed at all 78 CR centres in Sweden were surveyed and merged with patient-level registry data (n = 6755). Predictors of attaining low-density lipoprotein-cholesterol (LDL-C) and blood pressure (BP) targets and smoking abstinence were identified using orthogonal partial least squares discriminant analysis, generating variables of importance for the projection (VIP) values. Variables with VIP > 0.8 were considered meaningful. The strongest predictors for attaining LDL-C and BP targets included availability of psychosocial management, medication adjustment protocols for nurses, continuity in nurse-patient contact, extended opening hours and adequate facilities, and having a medical director at the CR centre. The strongest patient-level predictors of attaining LDL-C and/or BP targets included low baseline LDL-C and having no history of hypertension, respectively, and the patient having participated in exercise-based CR. For smoking abstinence, the strongest organizational predictors were availability of psychosocial management, having a medical director, prescribing nicotine replacement therapy and varenicline, and self-reported team spirit. Patient-level predictors included having participated in exercise-based CR and group education. Conclusion We identified multiple CR organizational predictors of attaining key risk factor targets after MI. These results may influence the future design of comprehensive CR programmes.
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Michelsen et al. (2026) conducted an observational in Myocardial infarction (n=6,755). Cardiac rehabilitation organizational and patient-level characteristics was evaluated on Attainment of low-density lipoprotein-cholesterol (LDL-C) and blood pressure (BP) targets and smoking abstinence at 1-year post-MI. Cardiac rehabilitation organizational factors, including psychosocial management and nurse medication protocols, strongly predicted risk factor target attainment 1-year post-MI (VIP > 0.8).
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