Barriers to participation in cardiac rehabilitation

Abstract

Background Participation rates in cardiac rehabilitation following myocardial infarction (MI) remain low. Studies investigating the predictive value of psychosocial variables are sparse and often qualitative. We aimed to examine the demographic, clinical, and psychosocial predictors of participation in cardiac rehabilitation after MI in the community. Methods Olmsted County, Minnesota residents hospitalized with MI between June 2004 and May 2006 were prospectively recruited, and a 46-item questionnaire was administered prior to hospital dismissal. Associations between variables and cardiac rehabilitation participation were examined using logistic regression. Results Among 179 survey respondents (mean age 64.8 years, 65.9% male), 115 (64.2%) attended cardiac rehabilitation. The median (25th–75th percentile) number of sessions attended within 90 days of MI was 13 (5–20). Clinical characteristics associated with rehabilitation participation included younger age (odds ratio [OR] 0.95 per 1-year increase), male sex (OR 1.93), lack of diabetes (OR 2.50), ST elevation MI (OR 2.63), receipt of reperfusion therapy (OR 7.96), in-hospital cardiologist provider (OR 18.82), no prior MI (OR 4.17), no prior cardiac rehabilitation attendance (OR 3.85), and referral to rehabilitation in the hospital (OR 12.16). Psychosocial predictors of participation included placing a high importance on rehabilitation (OR 2.35), feeling that rehabilitation was necessary (OR 10.11), better perceived health prior to MI (excellent vs. poor OR 7.33), the ability to drive (OR 6.25), and post-secondary education (OR 3.32). Conclusions Several clinical and psychosocial factors are associated with decreased participation in cardiac rehabilitation programs after MI in the community. As many are modifiable, addressing them may improve participation and outcomes.

Geographic issues in cardiac rehabilitation utilization: A narrative review

“…Table 1 summarizes nine studies (47.4% of all included findings) assessing rurality in relation to CR utilization (Harrison, Wardle 2005, Suaya et al 2007, King, Humen & Teo 1999, King et al 2001, Brady et al 2005, Johnson, Weinert & Richardson 1998, Higgins et al 2008, Smith, Harkness & Arthur 2006, Sundararajan et al 2004). Table 2 summarizes 10 studies (52.6% of all findings) which examined distance/travel time to CR (Ades et al 1992, Missik 2001, Suaya et al 2007, Yates, Braklow-Whitton & Agrawal 2003, Higgins et al 2008, Melville et al 1999, Grace et al 2008b, De Angelis, Bunker & Schoo 2008, Dunlay et al 2009, Brual et al 2010. All studies are presented in chronological order and when necessary, alphabetical order of the first author.…”

“…As shown in Table 2, of the 10 studies which assessed distance/travel time in relation to CR utilization (Ades et al 1992, Missik 2001, Suaya et al 2007, Yates, Braklow-Whitton & Agrawal 2003, Higgins et al 2008, Melville et al 1999, Grace et al 2008b, De Angelis, Bunker & Schoo 2008, Dunlay et al 2009, Brual et al 2010, six studies (60%) reported a significant negative relationship (Ades et al 1992, Suaya et al 2007, Yates, BraklowWhitton & Agrawal 2003, Higgins et al 2008, Grace et al 2008b, De Angelis, Bunker & Schoo 2008. Three studies (30%) showed no relationship between distance/Travel time to CR use (Missik 2001, Melville et al 1999, Dunlay et al 2009).…”

“…Overall, 12 out of 17 unique studies (70.6%) reviewed used objective geographic indicators, while the remaining five studies relied on self-report distance/time (Ades et al 1992, Missik 2001, Yates, Braklow-Whitton & Agrawal 2003, De Angelis, Bunker & Schoo 2008, Dunlay et al 2009). All nine studies testing the relationship of "rurality" to CR utilization used different definitions of geographic indicator such as urban versus rural, patients' location of residence, and degree of rurality or urbanization.…”

“…Three studies (30%) showed no relationship between distance/Travel time to CR use (Missik 2001, Melville et al 1999, Dunlay et al 2009). One study (10%) showed a mixed finding (Brual et al 2010).…”

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

“…Prior research on CR mainly focused on 2 areas: (1) identifying predictors for CR referral and initiation8, 9, 17, 18, 19, 20, 21 and (2) estimating the effects of CR participation with subsequent outcomes, such as mortality 22, 23, 24. For (1), the majority of evidence was collected from white males 25.…”