Cognitive Function and Cardiac Rehabilitation Attendance in Older Adults With Cardiovascular Disease Events: ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY

Purpose: Cardiovascular disease (CVD) and cognitive impairment are highly prevalent in older adults. This investigation explored the association of cognitive function with the likelihood of cardiac rehabilitation (CR) attendance following a CVD hospitalization. Methods: We studied 1262 participants of the Atherosclerosis Risk in Communities Study, aged 65 years of age or older, with CVD events eligible for CR, and with data linked to Medicare claims (1991–2015). Cognitive function was assessed using a comprehensive battery of neurocognitive tests administered at the study visit closest to the CVD event assessing executive function, expressive language, and short-term recall. Cardiac rehabilitation attendance was defined by Current Procedural Terminology codes reimbursed within 1 year following the index hospitalization. We used multivariable logistic regression to examine the association between quartiles of cognitive function and CR attendance. Results: The mean age of participants was 73.7 ± 5.5 years, 43% were female, 15% were Black, and 16% attended CR. Lower cognitive function was linearly associated with CR nonattendance. Compared with the highest quartile (Q4) of cognitive function as the referent, the adjusted OR of CR nonattendance was 2.47: 95% CI, 1.10-5.52 in quartile 1; 1.55: 95% CI, 0.81-2.97 in quartile 2; and 1.25: 95% CI, 0.69-2.26 in quartile 3. We did not find a significant interaction between race, sex, and CR attendance by cognitive function quartiles. Conclusions: Among older adults with CVD, lower cognitive function was robustly associated with CR nonattendance. Interventions aimed at increasing CR attendance should include strategies tailored to individual patient needs.