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

J Adv Nurs. 2025 Nov 5. doi: 10.1111/jan.70369. Online ahead of print.

ABSTRACT

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.

PMID:41191960 | DOI:10.1111/jan.70369