What is the clinical evidence from this study?

Study design: Observational. Population: coronary bypass surgery (n=4735). Intervention: Living inside Kermanshah (KSH) vs. Living outside Kermanshah (O-KSH). Primary outcome: Cardiac rehabilitation participation rate (p=<.001).

June 28, 2014

Outpatient Cardiac Rehabilitation Use After Coronary Bypass Surgery in the West of Iran

Q: What are the key findings of this study?

Living inside Kermanshah was associated with higher cardiac rehabilitation participation compared to living outside (27.0% vs 10.2%, P<0.001).

Key Result

Living inside Kermanshah was associated with higher cardiac rehabilitation participation compared to living outside (27.0% vs 10.2%, P<0.001).

Study Design

Type

Observational (n=4,735)

Multicenter

Structured PICO

Does systematic referral and a hybrid program model improve cardiac rehabilitation participation rates in patients after coronary bypass surgery?

Population

4,735 patients after coronary bypass surgery evaluated for cardiac rehabilitation referral and participation between 2002 and 2012.

Exposure

Systematic referral to cardiac rehabilitation and hybrid program model (combination of home-based and intermittent hospital-based sessions)

Comparator

Non-systematic referral and hospital-based program

Outcome

Cardiac rehabilitation referral, participation, and completion rates

Systematic referral and hybrid program models can significantly improve the low rates of cardiac rehabilitation participation after coronary bypass surgery in low- and middle-income countries.

Main Result

Absolute Event Rate: 27% vs 10.2%

p-value: p=<.001

Abstract

In Brief PURPOSE: Determinants of outpatient cardiac rehabilitation (CR) use in low- and middle-income countries are not well-known. This study analyzed CR use after coronary bypass surgery by gender and geography and effects of systematic referral, program model, and insurance types on CR participation in the west of Iran. METHODS: This observational study was conducted in Imam-Ali University Hospital in Kermanshah (KSH), the only CR center in the region (2002-2012). There were 2 CR programs: hospital-based and hybrid (combination of home-based and intermittent hospital-based sessions). Patients were divided into groups who lived inside and outside KSH (O-KSH). Referral, participation, and completion rates and program selection were compared by geography, gender, and insurance types. The effects of systematic referral (as of June 2011) were also analyzed. RESULTS: Of 4735 patients, 44.6% were referred for, 18.7% enrolled in, and 16.5% completed CR. In KSH compared with O-KSH, referral rates were 58.0% versus 30.7% and participation rates were 27.0% versus 10.2%, respectively (P < .001, in both cases). Participation rate in women was lower than that in men (15.6% vs 20.0%, respectively; P = .001). Systematic referral increased participation, especially in women and O-KSH (P < .001, in both cases). The O-KSH patients and those with unfavorable insurance mostly selected the hybrid program (P < .001, in both cases). Among participants, completion rates based on gender and geography were similar. CONCLUSIONS: Referral and participation rates of coronary bypass surgery patients in CR were low in the west of Iran, especially in women and O-KSH. Systematic referral along with the hybrid program increased them significantly. Referral and participation rates of coronary surgery patients in cardiac rehabilitation were low in the west of Iran, especially in patients who lived outside Kermanshah and in women. Systematic referral along with a hybrid program, the combination of home-based and intermittent hospital-based sessions, increased rates significantly.

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