Predictors of outpatient cardiac rehabilitation utilization: the Minnesota Heart Surgery Registry.

Abstract

A significant proportion of eligible patients do not participate in cardiac rehabilitation. The purpose of this study was to document patterns of outpatient cardiac rehabilitation use and identify factors predicting its use. The Acute Myocardial Infarction Registry of the Minnesota Heart Survey enrolled 3,841 patients admitted on suspicion of acute myocardial infarction (MI) to the coronary care units at six Minneapolis-St. Paul metropolitan hospitals. Participants were contacted 1 year after index hospitalization and asked if they participated in cardiac rehabilitation since discharge. Among those discharged with a MI, 47% participated in outpatient cardiac rehabilitation or an exercise program at an exercise facility, home, or both during the 1-year follow-up period. Among those discharged with angina, 21% attended cardiac rehabilitation. Usage increased when cardiac revascularization procedures were performed during the index hospitalization. Women with an angina or MI diagnosis were significantly less likely to use cardiac rehabilitation than men. Older patients were also less likely to use rehabilitation, with gender difference persisting across age strata. As education increased, cardiac rehabilitation utilization increased. Those not employed were less likely to use cardiac rehabilitation services. The strongest independent predictors of cardiac rehabilitation utilization were age and revascularization procedures (coronary artery bypass grafting or coronary angioplasty), simultaneously adjusting for demographic information, and cardiovascular disease risk factors. These data suggest that there is a disparity in cardiac rehabilitation utilization with lower rates among women, older individuals, those with less education, and the unemployed.