The Heterogeneous Trajectory of Adherence to Home-Based Cardiac Rehabilitation Exercises in Patients With Coronary Heart Disease: A Cohort Study.

AIMS: The aim of this study was to explore the trajectory of home-based cardiac rehabilitation exercise adherence in patients with coronary heart disease over 12 months and to identify heterogeneous trajectories and their predictors.

DESIGN

A prospective cohort study with 428 coronary heart disease patients was conducted in this study.

METHODS

The Latent Class Growth Model was adopted to describe exercise adherence trajectories, and heterogeneous adherence trajectory was determined based on the Cox proportional hazards regression model. Predictors were identified using a multivariable logistic regression model. The study was conducted from January 2023 to April 2024.

RESULTS

This study explored five adherence trajectories, including persistent adherence, gradual decline, U-shaped adherence, delayed initiation and consistent non-adherence. Two of these trajectories (gradual decline and consistent non-adherence) were merged and labelled as a heterogeneous adherence trajectory based on association with cardiovascular readmissions. Regression analysis revealed seven independent predictors for the heterogeneous trajectory, covering education level, ejection fraction, C-reactive protein level, frailty, depression, exercise motivation and work conditions.

CONCLUSIONS

The identification of distinct adherence trajectories and their predictors highlights the dynamic nature of cardiac rehabilitation engagement. Heterogeneous trajectories (gradual decline and non-adherence) were strongly linked to increased readmission risks, emphasising the need for targeted interventions in high-risk subgroups.

IMPACT: These findings provide a framework for nurses to stratify patients' adherence risks early and personalise rehabilitation strategies. Addressing modifiable predictors (e.g., depression management, frailty mitigation and motivation enhancement) could improve long-term adherence, reduce healthcare burdens from readmissions and optimise resource allocation in cardiac rehabilitation programmes.

REPORTING METHOD: The reporting procedure of this study followed the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.