Cardiac rehabilitation initiation among enrollees was associated with younger age, having a partner (OR 1.31; 95% CI 1.17-1.48), absence of diabetes, and prior CABG surgery (OR 1.64; 95% CI 1.09-2.47).
Observational (n=234,736)
Yes
What are the utilization rates and sociodemographic and clinical predictors of cardiac rehabilitation initiation in England?
Cardiac rehabilitation initiation in England is associated with younger age, having a partner, unemployment, absence of diabetes, and prior CABG, highlighting specific patient groups to target for improving enrollment.
BACKGROUND: Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation. METHODS AND RESULTS: Data from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees, using the Huber-White-sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234 736 (81.5%) patients referred to CR, 141 648 enrolled, 97 406 initiated CR, and of those initiating, 37.2% completed a program of ≥8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio OR 0.98, 95% CI 0.98-0.99), having a partner (OR 1.31, 95% CI 1.17-1.48), not being employed (OR 0.86, 95% CI 0.77-0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77-0.92), greater anxiety (OR 1.02, 95% CI 1.003-1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42-0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09-2.47). CONCLUSIONS: CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence-based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized.
Sumner et al. (Mon,) conducted a observational in Cardiac rehabilitation referral (n=234,736). Cardiac rehabilitation was evaluated on Cardiac rehabilitation initiation. Cardiac rehabilitation initiation among enrollees was associated with younger age, having a partner (OR 1.31; 95% CI 1.17-1.48), absence of diabetes, and prior CABG surgery (OR 1.64; 95% CI 1.09-2.47).