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Outpatient Cardiac Rehabilitation Attendance in England: VARIABILITY BY REGION AND CLINICAL CHARACTERISTICS

Bethell, Hugh MD; Lewin, Robert MPhil; Evans, Julia PhD; Turner, Sally PhD; Allender, Steven PhD; Petersen, Sophie PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: November-December 2008 - Volume 28 - Issue 6 - p 386–391
doi: 10.1097/HCR.0b013e31818c3b44
Cardiac Rehabilitation

PURPOSE Cardiac rehabilitation is an effective but underprovided treatment for patients recovering from acute cardiac events. The geographical spread of provision has not been investigated recently in any country. This study aimed to investigate the level of participation in cardiac rehabilitation programs of patients following myocardial infarction or revascularization (eligible patients) and the geographical equity of attendance.

METHODS Questionnaire data were collected from all cardiac rehabilitation centers in England for the year 2003/2004. The number of patients attending rehabilitation was compared with eligible patients across the 9 Government Office Regions of England as indicated by Hospital Episode Statistics.

RESULTS Nationally, 29% of eligible patients attended rehabilitation, while within various regions, the proportion of eligible patients participating in rehabilitation ranged between 14% (95% CI, 13.2–14.3) and 37% (95% CI, 36.6–37.6). Participation also differed significantly by primary cardiac event: myocardial infarction, 25%; percutaneous coronary intervention, 24%; and coronary artery bypass surgery, 66% (P < .001).

CONCLUSION The participation rate of eligible patients in cardiac rehabilitation was low in all regions. There were large differences between regions with widely varying incidence of attendance in different parts of the country.

We investigated cardiac rehabilitation provision in England. Twenty-nine percent of patients with acute myocardial infarction and postrevascularization attended cardiac rehabilitation in 2003/2004. There was a disparity in regional participation from 14% to 37%. Participation also differed by diagnosis from 25% for acute myocardial infarction to 66% for bypass surgery.

Basingstoke & Alton Cardiac Rehabilitation Centre, Alton, Hampshire, United Kingdom (Drs Bethell, Evans, and Turner); British Heart Foundation Care & Education Research Group, University of York, York, United Kingdom (Mr Lewin); British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford, Oxfordshire, United Kingdom (Drs Allender and Petersen).

Corresponding Author: Hugh Bethell, MD, Basingstoke & Alton Cardiac Rehabilitation Centre, Chawton Park Road, Alton, Hampshire, GU34 1RQ, United Kingdom (

© 2008 Lippincott Williams & Wilkins, Inc.