title: Factors associated with referral to outpatient cardiac rehabilitation services.
abstract: BACKGROUND
  Although practice guidelines and policy statements for cardiac rehabilitation recommend that it be offered to all patients with cardiovascular disease, the participation rates in most Western countries are low.
  
  
  OBJECTIVE
  This study aimed to determine the factors associated with referral to outpatient cardiac rehabilitation in the Hunter region of New South Wales, Australia.
  
  
  METHODS
  The study sample comprised 1933 patients discharged from public hospitals in the Hunter region between March 1, 1998 and February 28, 1999 who were eligible for cardiac rehabilitation, and for inclusion on the Hunter Area Heart and Stroke Register (the Register). Data were obtained from the Register database (gender, age, clinical information) and via a self-completed questionnaire eliciting referral, sociodemographic, and cardiovascular disease risk factor information. Multiple logistic regression analysis was conducted to determine the factors independently associated with referral.
  
  
  RESULTS
  : Of the respondents (1202/1933), 41% (493/1202; 95% confidence interval, 38-44%) reported that they had been referred to outpatient cardiac rehabilitation. The factors independently associated with referral were age younger than 65 years, previous participation in an outpatient cardiac rehabilitation program, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery.
  
  
  CONCLUSIONS
  Younger age, previous participation in outpatient cardiac rehabilitation, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery were associated with referral to cardiac rehabilitation. Research testing strategies designed to increase cardiac rehabilitation referral rates are needed and could include testing the potential role of modern quality management methods.
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medical Practice and Population Health, The University of Newcastle, NSW, Australia. Natalie.Johnson@newcastle.edu.au
authors.forename: Natalie
authors.initials: N
authors.lastname: Johnson
authors.forename: Janet
authors.initials: J
authors.lastname: Fisher
authors.forename: Amanda
authors.initials: A
authors.lastname: Nagle
authors.forename: Kerry
authors.initials: K
authors.lastname: Inder
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires