Cardiac rehabilitation in patients who underwent primary percutaneous coronary intervention for acute myocardial infarction: determinants of programme participation and completion

M Sunamura, N Ter Hoeve, M L Geleijnse, R V Steenaard, H J G van den Berg-Emons, H Boersma, R T van Domburg, M Sunamura, N Ter Hoeve, M L Geleijnse, R V Steenaard, H J G van den Berg-Emons, H Boersma, R T van Domburg

Abstract

Background: Hospital length of stay after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (pPCI) has reduced, resulting in more limited patient education during admission. Therefore, systematic participation in cardiac rehabilitation (CR) has become more essential. We aimed to identify patient-related factors that are associated with participation in and completion of a CR programme.

Methods: We identified 3,871 consecutive AMI patients who underwent pPCI between 2003 and 2011. These patients were linked to the database of Capri CR, which provides dedicated, multi-disciplinary CR. 'Participation' was defined as registration at Capri CR within 6 months after pPCI. CR was 'complete' if a patient undertook the final exercise test.

Results: In total, 1,497 patients (39%) were registered at Capri CR. Factors independently associated with CR participation included age (<50 vs. >70 year: odds ratio (OR) 7.0, 95% confidence interval (CI) 5.1-9.6), gender (men vs. women: OR 1.9, 95% CI 1.3-1.8), index diagnosis (ST-elevation myocardial infarction [STEMI] vs. non-ST-elevation myocardial infarction [NSTEMI]: OR 2.4, 95% CI 2.0-2.7) and socio-economic status (high vs. low: OR 2.0, 95% CI 1.6-2.5). The model based on these factors discriminated well (c-index 0.75). CR programme completion was 80% and was inversely related with diabetes, current smoking and previous MI. The discrimination of the model based on these factors was poor (c-index 0.59).

Conclusions: Only a minority of AMI/pPCI patients participated in a CR programme. Completion rates, however, were better. Increased physician and patient awareness of the benefits of CR are still needed, with focus on the elderly, women and patients with low socio-economic status.

Keywords: Cardiac rehabilitation; Completion rates; Participation rates; Percutaneous coronary intervention.

Conflict of interest statement

M. Sunamura, N. ter Hoeve, M.L. Geleijnse, R.V. Steenaard, H.J.G. van den Berg-Emons, H. Boersma and R.T. van Domburg declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participation rate over the years. Percentages of patients after primary percutaneous coronary intervention for acute myocardial infarction who participated in cardiac rehabilitation

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