Barriers to participation in cardiac rehabilitation

Abstract

Background: Participation rates in cardiac rehabilitation after 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 before 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 before 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.

Figures

Figure 1. Clinical Characteristics of Cardiac Rehabilitation Participants and Non-Participants

Caption: Selected patient clinical characteristics by cardiac rehabilitation participation status are shown. STEMI= ST segment elevation myocardial infarction; MI= myocardial infarction

Figure 2. Psychosocial Characteristics of Cardiac Rehabilitation Participants and Non-Participants

Caption: Patient-reported psychosocial characteristics by cardiac rehabilitation participation status are shown.

Figure 3. Clinical Characteristics of Patients Referred and Not Referred to Cardiac Rehabilitation

Caption: Differences in patient characteristics according to whether they received an in-hospital referral to cardiac rehabilitation are shown.