Abstract 17021: Predictors of Attendance to Cardiac Rehabilitation in a Diverse Urban Population

Abstract

BACKGROUND: Cardiac rehabilitation (CR) improves outcomes following a coronary event, but CR remains underutilized. Little has been published about predictors of CR in an urban population. We hypothesized that standard predictors of CR attendance would be different from previous reports when tested in a diverse, metropolitan population.

METHODS: As part of a randomized trial testing an early vs. late appointment time, patients with non-surgical qualifying diagnosis for CR were evaluated. Predictors of attendance at CR orientation were collected prospectively using a structured questionnaire. Groups were analyzed for differences.

RESULTS: Of 148 patients, 101 (68%) attended CR. Univariate predictors of attendance are shown in table 1. Tobacco abuse, prior MI, prior angina, implantable cardioverter defibrillator (ICD) and lack of insurance were each associated with lower attendance rates. Unlike prior literature, older age was associated with improved attendance. Previously negative predictors such as race, gender, and distance to CR from home, body mass index (BMI), history of congestive heart failure and ejection fraction were not predictors of attendance (p > 0.05 for all.) Of the 65 employed patients, home financial stress with an immediate need to return to work was predictive of poorer attendance at CR (p = 0.013), where as employment status was not (p = 0.11) In a multi-variate logistic regression model, however, only prior MI (OR 0.31, CI 0.14-0.68, p=0.003) and tobacco abuse (OR 0.29, CI 0.14-0.63, p=0.002) remained associated with worse attendance.

CONCLUSION: In a diverse urban setting, we found that properly referred elderly patients were more likely to attend CR and that an immediate financial need to return to work, more so than employment status, was predictive of attendance. Patients with prior MI and smokers constitute a subgroup that needs extra attention from CR personnel due their lower attendance.