PREDICTORS OF CARDIAC REHABILITATION UTILIZATION 1581

Abstract

While many people are eligible for outpatient cardiac rehabilitation, some studies suggest that a substantial proportion do not participate. The purpose of this study was to document utilization of cardiac rehabilitation and to identify factors predicting its use. The Acute Myocardial Infarction (MI) Registry of the Minnesota Heart Survey enrolled 3841 patients admitted to the coronary care unit with suspect MI at six Minneapolis - St. Paul metropolitan area hospitals. Participants were contacted one year following index hospitalization. Among those discharged with a MI, 47% attended outpatient cardiac rehabilitation at an exercise facility, at home, or both during the one year follow-up period. Utilization among angina patients was 21%. Usage increased when cardiac revascularization procedures were performed during the index hospitalization. Utilization was 59% among MI patients who received coronary artery bypass grafting (CABG) surgery and 56% among MI patients who received coronary angioplasty (PTCA). For angina patients who received CABG surgery attendance increased to 58%, and for angina patients receiving PTCA usage was 26%. Women were significantly less likely to utilize cardiac rehabilitation (41% male, 23% female p<0.01). Older patients were also less likely to be referred to or attend rehabilitation (25-49 years at 48%, 50-59 years at 46%, 60-69 years at 37%, 70-79 years at 29%, 80+ years at 13%), with the gender difference persisting across age strata. As years of education increased, cardiac rehabilitation utilization increased. After accounting for demographic information, cardiovascular disease risk factors, revascularization procedures (CABG or PTCA), and discharge diagnosis (MI or angina), the strongest independent predictors of cardiac rehabilitation utilization were revascularization procedures and discharge diagnosis. This study suggests that outpatient cardiac rehabilitation continues to be underutilized. This information can be used by physicians and rehabilitation personnel to better target patient education and programming to increase participation in cardiac rehabilitation.