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Cardiac Rehabilitation Enrollment Among Referred Patients: PATIENT AND ORGANIZATIONAL FACTORS

Turk-Adawi, Karam I. PhD; Oldridge, Neil B. PhD; Tarima, Sergey S. PhD; Stason, William B. MD; Shepard, Donald S. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: March/April 2014 - Volume 34 - Issue 2 - p 114–122
doi: 10.1097/HCR.0000000000000017
Cardiac Rehabilitation

PURPOSE: Cardiac rehabilitation (CR) is underutilized despite well-documented benefits for patients with coronary heart disease. The purpose of this study was to identify organizational and patient factors associated with CR enrollment.

METHODS: Facilities of the Wisconsin Cardiac Rehabilitation Outcomes Registry (N = 38) were surveyed, and the records of referred patients were analyzed. Generalized estimating equations were used to account for clustering of patients within facilities.

RESULTS: Of the 6874 patients referred to the 38 facilities, 67.6% (n = 4,644) enrolled in CR. Patients receiving coronary artery bypass grafting (adjusted odds ratio [OR], 1.72; 95% CI: 1.36–2.19) and those who possessed health insurance (OR, 3.04; 95% CI: 2.00–4.63) were more likely to enroll. Enrollment was also positively impacted by organizational factors, including promotion of CR program (OR, 2.35; 95% CI: 1.39–4.00), certification by the American Association of Cardiovascular Pulmonary Rehabilitation (OR, 2.63; 95% CI: 1.32–5.35), and a rural location (OR, 3.30; 95% CI: 2.35–4.64). Patients aged ≥65 years (OR, 0.81; 95% CI: 0.74–0.90) and patients with heart failure (OR, 0.40; 95% CI: 0.22–0.72), diabetes (OR, 0.58; 95% CI: 0.37–0.89), myocardial infarction without a cardiac procedure (OR, 0.78; 95% CI: 0.67–0.90), previous coronary artery bypass grafting (OR, 0.72; 95% CI: 0.56–0.92), depression (OR, 0.56; 95% CI: 0.36–0.88), or current smoking (OR, 0.59; 95% CI: 0.44–0.78) were less likely to enroll.

CONCLUSIONS: Predictors of patient enrollment in CR following referral included both organizational and personal factors. Modifiable organizational factors that were associated either positively or negatively with enrollment in CR may help directors of CR programs improve enrollment.

We examined the relationship between organizational and personal factors and cardiac rehabilitation (CR) enrollment. Organizational and patient factors were associated with CR enrollment. Modifiable organizational factors included CR promotion to patients and providers, certification by the American Association of Cardiovascular Pulmonary Rehabilitation, and rural location of the CR facility.

Brandeis University, Waltham, Massachusetts (Drs Turk-Adawi, Stason, and Shepard); Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin (Dr Oldridge); and Division of Biostatistics, Medical College of Wisconsin, Milwaukee (Dr Tarima).

Correspondence: Karam I. Turk-Adawi, PhD, c/o Donald Shepard, Brandeis University, 415 S St, MS 035, Waltham, MA 02454 (

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins