Abstract 13349: Predictors of Early and Late Enrollment in Cardiac Rehabilitation, Among Those Referred, after Acute Myocardial Infarction

Abstract

Background: Although referral to CR after an AMI has recently become a performance measure, many patients may not participate. To illuminate potential barriers to participation, we examined the prevalence of, and patient related factors associated with, CR participation within 1 and 6-months after an AMI.

Methods: We studied 2096 AMI patients enrolled from 19 US sites in the PREMIER registry. Analyses were limited to those patients referred for CR at the time of AMI hospitalization. A multivariable, conditional logistic regression model, stratified by hospital, was used to identify socio-demographic, comorbidity and clinical factors independently associated with CR participation within 1 and 6-months of AMI hospital discharge.

Results: Only 29% (419/1450) and 48.25% (650/1347) of AMI patients who received referral for CR participated within 1 and 6-months after discharge respectively. Women (odds ratio (OR) = 0.61; 95% CI; = 0.44, 0.86), uninsured (OR=0.39, 95% CI= 0.21, 0.71) and patients with hypertension (OR=0.58; 95% CI = 0.43, 0.78) and peripheral arterial disease (PAD) (OR=0.43; 95% CI = 0.22, 0.85) were less likely to participate at 1-month. At 6-months after AMI, older patients (OR=0.85 for each 10-year increment; 95% CI = 0.74, 0.97), smokers (OR=0.59; 95% CI = 0.44, 0.80) and patients with economic burden (OR=0.56; 95% CI = 0.38, 0.81) were less likely to participate. Caucasians (OR=1.73; 95% CI = 1.16, 2.58) and educated patients (OR=1.81; 95% CI = 1.42, 2.30) were more likely to participate at 6-month. Patients with prior prior percutaneous interventions (PCI) were less likely to participate at both 1 and 6-months post-AMI.

Conclusions: Among patients referred for CR post-AMI, participation remains low both at 1 and 6 months after AMI. Since CR is associated with beneficial changes in cardiovascular risk factors and better outcomes after AMI, more aggressive efforts are needed to increase CR participation after referral.