Barriers to participation in cardiac rehabilitation.
BACKGROUND
Participation rates in cardiac rehabilitation after myocardial infarction (MI) remain low. Studies investigating the predictive value of psychosocial variables are sparse and often qualitative. We aimed to examine the demographic, clinical, and psychosocial predictors of participation in cardiac rehabilitation after MI in the community.


METHODS
Olmsted County, Minnesota, residents hospitalized with MI between June 2004 and May 2006 were prospectively recruited, and a 46-item questionnaire was administered before hospital dismissal. Associations between variables and cardiac rehabilitation participation were examined using logistic regression.


RESULTS
Among 179 survey respondents (mean age 64.8 years, 65.9% male), 115 (64.2%) attended cardiac rehabilitation. The median (25th-75th percentile) number of sessions attended within 90 days of MI was 13 (5-20). Clinical characteristics associated with rehabilitation participation included younger age (odds ratio [OR] 0.95 per 1-year increase), male sex (OR 1.93), lack of diabetes (OR 2.50), ST-elevation MI (OR 2.63), receipt of reperfusion therapy (OR 7.96), in-hospital cardiologist provider (OR 18.82), no prior MI (OR 4.17), no prior cardiac rehabilitation attendance (OR 3.85), and referral to rehabilitation in the hospital (OR 12.16). Psychosocial predictors of participation included placing a high importance on rehabilitation (OR 2.35), feeling that rehabilitation was necessary (OR 10.11), better perceived health before MI (excellent vs poor OR 7.33), the ability to drive (OR 6.25), and post-secondary education (OR 3.32).


CONCLUSIONS
Several clinical and psychosocial factors are associated with decreased participation in cardiac rehabilitation programs after MI in the community. As many are modifiable, addressing them may improve participation and outcomes.
Dunlay
Shannon M
SM
Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Witt
Brandi J
BJ
Allison
Thomas G
TG
Hayes
Sharonne N
SN
Weston
Susan A
SA
Koepsell
Ellen
E
Roger
Véronique L
VL
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires