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. 2024 Apr 11;58(5):328-340.
doi: 10.1093/abm/kaae008.

Associations Between Psychological Factors and Adherence to Health Behaviors After Percutaneous Coronary Intervention: The Role of Cardiac Rehabilitation

Emma R Douma  1 , Willem J Kop  1 , Nina Kupper  1
Affiliations

Associations Between Psychological Factors and Adherence to Health Behaviors After Percutaneous Coronary Intervention: The Role of Cardiac Rehabilitation

Emma R Douma et al. Ann Behav Med. .

Abstract

Background: Cardiac rehabilitation (CR) participation after percutaneous coronary intervention (PCI) for coronary heart disease lowers the disease burden and risk of recurrent cardiac events. Examining psychological factors may improve post-PCI health behavior adherence.

Purpose: To determine whether psychological factors are associated with post-PCI health behavior adherence, and the role of CR participation.

Methods: Data from 1,682 patients (22.1% female, Mage = 64.0, SDage = 10.5 years) from the THORESCI cohort were included. Adjusted mixed models were used to examine associations between psychological factors and the 1-year course of health behaviors, using interactions to test for moderation by CR participation.

Results: Psychological factors were associated with the trajectories of adherence to medical advice, exercise, and diet. The strongest association found was between optimism and the trajectory of dietary adherence (B: = -0.09, p = .026). Patients with high optimism levels had a worse trajectory of dietary adherence compared to patients with low to middle optimism levels. Participation in CR buffered the associations of high anxiety, pessimism, and low to middle resilience, but strengthened the associations of high stress in the past year with the probability of smoking.

Conclusions: Psychological factors are associated with post-PCI health behavior adherence, but the pattern of associations is complex. Patients with high levels of anxiety, pessimism, and low to middle resilience levels may disproportionately benefit from CR. Cardiac rehabilitation programs could consider this to improve post-PCI health behavior adherence.

Clinical trials registration #: NCT02621216.

Keywords: Cardiovascular rehabilitation; Coronary heart disease; Health behavior change; Percutaneous coronary intervention; Psychological factors.

Plain language summary

For patients with coronary heart disease who have undergone percutaneous coronary intervention (PCI), participating in cardiac rehabilitation (CR) reduces the disease burden and the risk of future cardiac events. However, adherence to the health behaviors targeted in CR could be improved. Using data from 1,682 patients included in the THORESCI study, we explored whether psychological factors could predict health behavior adherence and the role of participation in CR. Results revealed that psychological factors were linked to adherence to medical advice, exercise, and diet. Overall, patients with low to moderate optimism levels exhibited more favorable changes in healthy dietary habits than patients with high levels of optimism. Participation in CR made the link between high anxiety, pessimism, low to moderate resilience, and lower adherence to health behaviors less strong. Cardiac rehabilitation programs could use these results to enhance the health behavior adherence of patients who have undergone PCI.

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Figures

Fig. 1.
Fig. 1.
Model of patient complexity, adapted from Shippee et al. [12].
Fig. 2.
Fig. 2.
(a) Mean score on exercise adherence over time. (b) Mean score on medication non-adherence over time. (c) Mean score on dietary adherence over time. (d) Mean score on stress reduction over time.
Fig. 3.
Fig. 3.
(a) Estimated marginal means of adherence to medical advice (Medical Outcomes Study [MOS] subscale) over time by level of resilience. (b) Estimated marginal means of exercise adherence (MOS subscale) over time by level of optimism. (c) Estimated marginal means of dietary adherence (MOS subscale) over time by level of depressive symptoms. (d) Estimated marginal means of dietary adherence (MOS subscale) over time by level of anxiety. (e) Estimated marginal means of dietary adherence (MOS subscale) over time by level of optimism. (f) Estimated marginal means of dietary adherence (MOS subscale) over time by CR participation.
Fig. 4.
Fig. 4.
(a) Estimated marginal means of adherence to medical advice (MOS subscale) over time by level of anxiety for people not participating in cardiac rehabilitation (CR). (b) Estimated marginal means of adherence to medical advice (MOS subscale) over time by level of anxiety for people participating in CR. (c) Estimated marginal means of dietary adherence (MOS subscale) over time by level of pessimism for people not participating in CR. (d) Estimated marginal means of dietary adherence (MOS subscale) over time by level of pessimism for people participating in CR. (e) Estimated marginal means of dietary adherence (MOS subscale) over time by level of resilience for people not participating in CR. (f) Estimated marginal means of dietary adherence (MOS subscale) over time by level of resilience for people participating in CR. (g) Probability of not smoking over time by level of stress in the past year for people not participating in CR. (h) Probability of not smoking over time by level of stress in the past year for people participating in CR.
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