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A Motivational Telephone Intervention to Reduce Early Dropouts in Cardiac Rehabilitation


LaValley, Grace DNP, AGACNP-BC; Storer, Andrew DNP, ACNP-BC, FNP-C, ENP-C; Szalai, Heidi MA, ACSM-CEP; Farah, Michel MD; Pack, Quinn R. MD, MSc

Journal of Cardiopulmonary Rehabilitation and Prevention: September 2019 - Volume 39 - Issue 5 - p 318–324
doi: 10.1097/HCR.0000000000000425
Cardiac Rehabilitation

Purpose: Cardiac rehabilitation (CR) improves outcomes, yet early dropout is common. The purpose of the study was to determine whether a motivational telephone intervention among patients at risk for nonadherence would reduce early dropouts.

Methods: We performed a randomized double-blind pilot study with the intervention group receiving the telephone intervention 1 to 3 d after outpatient CR orientation. The control group received the standard of care, which did not routinely monitor attendance until 2 wk after orientation. The primary outcome was the percentage of patients who attended their second exercise session as scheduled. Secondary outcomes included attendance at the second CR session at any point and total number of sessions attended. Because not everyone randomized to the intervention was able to be contacted, we also conducted a per-protocol analysis.

Results: One hundred patients were randomized to 2 groups (age 62 ± 15 yr, 46% male, 40% with myocardial infarction) with 49 in the intervention group. Patients who received the intervention were more likely to attend their second session as scheduled compared with the standard of care (80% vs 49%; relative risk = 1.62; 95% CI, 1.18-2.22). Although there was no difference in total number of sessions between groups, there was a statistically significant improvement in overall return rate among the per-protocol group (87% vs 66%; relative risk = 1.31; 95% CI, 1.05-1.63).

Conclusions: A nursing-based telephone intervention targeted to patients at risk for early dropout shortly after their CR orientation improved both on-time and eventual return rates. This straightforward strategy represents an attractive adjunct to improve adherence to outpatient CR.

This study evaluated the effect of a telephone intervention on patients who were considered at risk for nonadherence to cardiac rehabilitation. We found that patients who received the intervention were more likely to attend their second session as scheduled compared with the program's standard of care.

Baystate Health Systems, Springfield, Massachusetts (Drs LaValley, Farah, and Pack and Mrs Szalai); Elms College, Chicopee, Massachusetts (Drs LaValley and Storer); University of Massachusetts Medical School at Baystate, Springfield (Dr Pack); and Center for Health Care Delivery and Population Science, Springfield, Massachusetts (Dr Pack).

Correspondence: Grace LaValley, DNP, AGACNP-BC, Baystate Health Systems, 759 Chestnut Street, Springfield, MA 01199 (

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, participation in speakers' bureaus, memberships, employment, stock ownership, or other equity interest) or nonfinancial interest (such as personal or professional relationships affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Dr Quinn R. Pack was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (award number: KL2TR001063). The content is solely the responsibility of the authors and does not represent the official views of the NIH.

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