Abstract 152: Factors Associated With Enrollment In Cardiac Rehabilitation: A Single-center Experience

Abstract

Introduction: Cardiac rehabilitation (CR) is a vital component of secondary prevention shown to reduce mortality and improve quality of life. Despite this, referral to CR is low compared to other secondary prevention measures and enrollment of those referred is variable. We examined factors that are associated with enrollment to better understand ways in which participation in CR can be improved. Methods: Using data from the CR Center at the University of Michigan Health System, we analyzed 2012 patients who were referred to CR from January 1, 2008 to June 1, 2013. We systematically performed forward, step-wise multiple logistic regression to determine the best model for predicting acceptance of referral to CR. The outcome variable of interest was enrollment in CR if referred to CR. Results: Of the 2012 patients referred to CR, 1334 patients (66.3%) attended at least one session of CR. While there were no differences in age, gender or race between the two cohorts, there were several differences in baseline characteristics between those who enrolled vs. those who did not enroll. Those who enrolled in CR were more likely to be married (74.5% vs. 61.4%, P<0.0001), employed (54.2% vs. 29.8%, P<0.0001), insured (99.6% vs. 96.3%, P<0.0001), and have two or more co-morbidities (51.5% vs. 41.7%, P <0.0001). In the multiple logistic regression model, factors associated with enrollment (in descending order) were private insurance vs. none (OR=10.8; 95% CI 2.17-53.28, P=0.004), coronary artery bypass grafting vs. MI/ACS (OR= 3.42; 95% CI 1.68-6.99, P=0.0007), referral from cardiac surgery vs. cardiology (OR 3.15; 95% CI 1,43-6.95, P=0.004), outpatient vs. inpatient referral (OR=2.1, 95% CI 1.5 -2.9 , P=0.0001), unemployed (OR=1.55; 95% CI 1.09-2.2, P=0.01), and married (OR=1.41, 95% CI 1.04-1.92, P=0.01). Conclusion: Several patient and system-level factors are associated with enrollment in CR for those who were referred to CR at a single institution. These patient and organizational level variables represent opportunities for targeted interventions to improve CR utilization.