Predictors of Early and Late Enrollment in Cardiac Rehabilitation, Among Those Referred, After Acute Myocardial Infarction

Susmita Parashar, MD, MPH, MS;John A. Spertus, MD, MPH; Fengming Tang, MS; Kathy L. Bishop, MS; Viola Vaccarino, MD, PhD; Charles F. Jackson, MD; Thomas F. Boyden, MD; Laurence Sperling, MD

Circulation. 2012; 126: 1587-1595

Abstract
Background—Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is a Class I recommendation. Although referral to CR after an AMI has recently become a performance measure, many patients may not participate. To illuminate potential barriers to participation, we examined the prevalence of, and patient-related factors associated with, CR participation within 1 and 6 months after an AMI.

Methods and Results—We studied 2096 AMI patients enrolled from 19 US sites in the Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery (PREMIER) registry. Analyses were limited to those patients referred for CR at the time of AMI hospitalization. A multivariable, conditional logistic regression model, stratified by hospital, was used to identify sociodemographic, comorbidity, and clinical factors independently associated with CR participation within 1 and 6 months of AMI hospital discharge. Only 29% (419/1450) and 48.25% (650/1347) of AMI patients who received referral for CR participated within 1 and 6 months after discharge, respectively. Women (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.44–0.86), uninsured (OR, 0.39; 95% CI, 0.21–0.71), and patients with hypertension (OR, 0.58; 95% CI, 0.43–0.78) and peripheral arterial disease (OR, 0.43; 95% CI, 0.22–0.85) were less likely to participate at 1 month. At 6 months after AMI, older patients (OR, 0.85 for each 10-year increment; 95% CI, 0.74–0.97), smokers (OR, 0.59; 95% CI, 0.44–0.80), and patients with economic burden (OR, 0.56; 95% CI, 0.38–0.81) were less likely to participate. Caucasians (OR, 1.73; 95% CI, 1.16–2.58) and educated patients (OR, 1.81; 95% CI, 1.42–2.30) were more likely to participate at 6 months. Patients with previous percutaneous interventions were less likely to participate at both 1 and 6 months post-AMI.

Conclusions—Among patients referred for CR post-AMI, participation remains low both at 1 and 6 months after AMI. Because CR is associated with beneficial changes in cardiovascular risk factors and better outcomes after AMI, more aggressive efforts are needed to increase CR participation after referral.