Abstract 11515: Selection Bias May Influence Who is Offered Cardiac Rehabilitation
Purpose: The clinical benefits of cardiac rehabilitation (CR) are well established; however, participation rates remain low. This study was undertaken to describe the differences in patient characteristics and perceptions among eligible patients who were offered and enrolled (“ENROLLED”) in CR, who were offered but did not enroll (“OFFERED”) in CR, and who were not offered CR (“NOT OFFERED”).
Methods: Respondents from the 2010-2012 United States National Health and Wellness Survey, a nationwide health-survey of adults, were recontacted to participate in a follow-up, self-administered, Internet-based survey. A total of 304 respondents met the inclusion criteria (aged 41+ years and hospitalized in the past two years for a cardiac-related condition) and completed the survey. Responses were analyzed for differences between the three categories of experience with CR: OFFERED, ENROLLED, and NOT OFFERED.
Results: A total of 126 (41%), 75 (25%), and 103 (34%) respondents were ENROLLED in, OFFERED, and NOT OFFERED CR, respectively. Age (64 to 66 years), sex (71% to 76% were male), and ethnicity (86% to 91% were white) distributions were similar across all three groups. Compared to those NOT OFFERED, those ENROLLED had the poorest health profile prior to their last cardiac event including the highest body mass index (BMI: 32 vs. 29), poorest medication adherence (86% were adherent vs. 93%), and lowest rates of healthy eating (43% vs. 54%) yet had the most financial ($65.6K annual income vs. $40.5K) and supportive resources (66% vs. 45% married) (all p<.05). Similar differences were observed between those ENROLLED and those OFFERED. Those who ENROLLED were more likely to have been originally offered the CR program by a cardiologist (87% vs. 59%) and shown data of the benefits (35% vs. 14%) compared with those who were OFFERED (both p<.05).
Conclusions: The results suggest that certain patients, particularly those with a poorer health profile and more financial and supportive resources, may be more likely to be offered a CR program. Who recommends CR and how it is recommended may also affect the probability of enrollment. Given the efficacy of CR, greater attention may need to be focused on offering the service to a wider array of patients.
- © 2013 by American Heart Association, Inc.