What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease (n=1273). Intervention: Older age (≥65 years) vs. Younger age (<65 years). Primary outcome: Total cardiac rehabilitation barriers score (p=<0.001).

May 1, 2009Open Access

Barriers to Cardiac Rehabilitation

Q: What are the key findings of this study?

Older cardiac patients reported a significantly higher total burden of barriers to cardiac rehabilitation compared to younger patients (mean score 2.6 vs 2.4, p<0.001).

SGSherry L. GracePreventive Cardiology SSShamila ShanmugasegaramPublic Health Agency of Canada SGShannon Gravely‐WitteUniversity Health Network

Key Result

Older cardiac patients reported a significantly higher total burden of barriers to cardiac rehabilitation compared to younger patients (mean score 2.6 vs 2.4, p<0.001).

Study Design

Type

Observational (n=1,273)

Multicenter

Yes

Structured PICO

Population

1,273 outpatients with coronary artery disease, mean age 65.9 years, who completed a 9-month follow-up survey assessing barriers to cardiac rehabilitation.

Outcome

Self-reported barriers to cardiac rehabilitation enrollment and participation rated on a 18-item 5-point Likert scalepatient reported

Older cardiac patients report significantly more barriers to cardiac rehabilitation participation, highlighting the need for targeted interventions to address modifiable factors like physician encouragement.

Main Result

Absolute Event Rate: 2.6% vs 2.4%

p-value: p=<0.001

Limitations

Use of investigator-generated items rather than a psychometrically validated scale of CR barriers
Characteristics of the retained sample differed from those lost to follow-up, potentially affecting generalizability
Multiple comparisons introduced the potential for inflated error rates
Observational study design precludes causal conclusions

Abstract

In Brief PURPOSE To quantitatively investigate age differences in barriers to cardiac rehabilitation (CR) enrollment and participation. METHODS Cardiac outpatients (N = 1,273, mean age = 65.9 ± 11.2) completed a mailed survey to discern barriers to CR enrollment and participation. Both enrollees and nonenrollees were asked to rate 18 CR barriers on a 5-point Likert scale. RESULTS Of the respondents, 535 (43%) reported participating in CR at 1 of 40 sites, with younger patients being more likely to participate (P = .002). Older age was positively related to total CR barriers (P < .001). Older patients more strongly endorsed the following CR barriers: already exercising at home (P = .001), confidence in ability to self-manage their condition (P = .003), perception of exercise as tiring or painful (P = .001), not knowing about CR (P = .001), lack of physician encouragement (P < .001), comorbidities (P < .001), and perception that CR would not improve their health (P < .001). CONCLUSION Given that the benefits of CR are achieved in older patients as well as the young, interventions to overcome these modifiable barriers to enrollment and participation are needed. Compared with younger patients, older patients more strongly identified several barriers to cardiac rehabilitation (CR) participation including already exercising at home, confidence in ability to self-manage condition, perception of exercise as tiring or painful, not knowing about CR, lack of physician encouragement, comorbidities, and perception that CR is ineffective.

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