Predictors of Early and Late Enrollment in Cardiac Rehabilitation, Among Those Referred, after Acute Myocardial Infarction
Background—Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is a Class I recommendation. 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 and Results—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. 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.
- Received January 3, 2012.
- Accepted August 10, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited