Intention, beliefs and mood assessed using electronic diaries predicts attendance at cardiac rehabilitation: an observational study

Background: Cardiac rehabilitationis effective in promoting physical/psychological recovery following acute coronary syndrome. Yet, rates of attendanceat outpatient cardiac rehabilitationby eligible patients are low. Objectives: This study examined the determinants of attendanceat outpatient cardiac rehabilitationin acute coronary syndromepatients following discharge until cardiac rehabilitationcommencement. Design: A weekly electronic diary measured cardiac-related cognitions and mood and examined their relation to attendanceat outpatient cardiac rehabilitation. Settings: Three United Kingdom National Health Service secondary care settings in two Health Board areas in Scotland. Participants: Acute coronary syndromepatients were recruited from March 2012 to June 2013 prior to hospital discharge. Of 488 eligible patients referred for cardiac rehabilitation, 214 consented. Results: 166 participants provided, on average, 5 weeks of diary entries before cardiac rehabilitationcommenced. High intention (i.e. low “do not intend”) to attendCR and its rate of increase over timepredicted attendance. Low negative emotional representation, high perceived necessity, high confidence in maintaining function, low negative affect, and high positive affect following discharge predicted attendanceat cardiac rehabilitation. The rate of change in cardiac-related mood and these cognitions was not predictive. Baseline and rate of change in “do not intend” entirely mediated relationships between a) perceived necessity, b) negative affectand attendanceat cardiac rehabilitation. Conclusions: Negative affectin the first weeks following discharge represents the key challenge to a patient maintaining their intention to attendcardiac rehabilitation. Intervention to improve attendanceshould focus on improving intention to attendfollowing discharge and during recovery by improving patient understanding of cardiac rehabilitationand reducing negative affect.