Cardiac rehabilitation: socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited

Abstract

Patients not receiving secondary prevention were less likely to be invited to cardiac rehabilitation. Social deprivation was the only factor significantly associated with poor uptake of cardiac rehabilitation in both years. There was no diVerence in the use of secondary prevention between those who did and did not attend cardiac rehabilitation. Conclusion-Those invited to attend a cardiac rehabilitation programme are likely to be in a good prognosis group, comprising those who are young and have received thrombolysis. Those at greatest risk, particularly patients from socially deprived areas, seem to be missing out on the potential benefits of cardiac rehabilitation. High risk patients should be specifically targeted to ensure that they are invited to, and encouraged to, attend a programme of cardiac rehabilitation.

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.…”

“…Three non-self-report tools were used: (1) GIS which calculates distance and drive-time based on geographic and spatial information (Higgins et al 2008, Melville et al 1999, Grace et al 2008b, Brual et al 2010; (2) the US 2000 Census data and linked zip codes to levels of urbanization in which five quintiles were used to classify distance from CR site (Suaya et al 2007); (3) as well as the cut-off of 30 minutes drive time to define "Accessible" health care services (Brady et al 2005).…”

“…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).…”

“…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).…”

The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence

“…Surveys from the UK show levels of participation between 14 and 43%. 7,[36][37][38][39] Similarly low uptake rates are reported from Australia, 40 New Zealand, 41 the USA [42][43][44] and France. 45 Of those patients who do attend hospital CR, the drop-out rates from exercise programmes generally range from 20% in the first 3 months to 50% at 6 months to 1 year, but can be as high as 87% by 1 year.…”