Rehabilitation enrollment after cardiac procedures

Background: Cardiac rehabilitation programmes are effective for implementing secondary prevention in coronary heart disease. Variables influencing the rate of rehabilitation enrollment after PCI or CABG are largely unknown. Methods: A cohort of consecutive patients were interviewed 6–8 weeks after cardiac interventions to assess the reasons, as well as demographic and comorbid variables influencing rehabilitation enrollment. Results: Among 309 patients, 160 (52%) responded to structured personal or telephone interviews. After PCI, 29/78 (37%) patients were enrolled in rehabilitation programmes and after CABG 79/82 (96%) (p <0.001). Lack of information or missing referral were the main reasons for not participating in rehabilitation (44% of patients after PCI). Multivariate regression analysis showed significant independent variables predicting participation: cardiac surgery (OR = 58; 95% CI 12.8–261.5, p <0.001), being depressed according to the screening questions of Arroll (OR = 0.26; 95% CI 0.08– 0.88, p = 0.031). Lower age and complications during hospitalisation were additional significant univariate predictors for participation. Multivariate analysis revealed predictors for selection of an invs outpatient rehabilitation programme: Cardiac surgery (OR = 54; 95% CI 6.4–460.2, p <0.001), nonsmoking status (OR = 22; 95%CI 2.5–194.0, p <0.005), presence of a comorbid condition (OR = 7; 95% CI 1.4–35.7, p <0.02), living alone (OR =0.04; 95% CI 0.005–0.36, p <0.004). Female gender was an additional univariate predictor for inpatient rehabilitation. Conclusions: Rehabilitation enrollment is unsatisfactory after PCI, in contrast to cardiac surgery, mostly due to the lack of standardised information or referral policies. Independent predictors of participation are lower age, surgical intervention and absence of depressive symptoms. Predictors for selecting inpatient vs outpatient programmes were complications after the index procedure and comorbidities.