title: Cardiac rehabilitation uptake and its determinants in the Netherlands.
abstract: OBJECTIVE
  Despite its documented efficacy, cardiac rehabilitation (CR) is still not well implemented in current clinical practice. The aims of the present study were to assess CR uptake rates in the Netherlands, and to identify factors that determine uptake.
  
  
  METHODS
  The cohort consisted of persons insured with Achmea Zorg en Gezondheid. Based on insurance claims, we assessed CR uptake rates in 2007 among patients with an acute coronary syndrome (ACS), patients who underwent coronary artery bypass graft surgery, percutaneous coronary intervention (PCI), or valvular surgery, and patients with stable angina pectoris (AP) or chronic heart failure (CHF). In addition, we evaluated the relation between CR uptake and demographic, disease-related, and geographic factors for patients with an ACS and/or intervention.
  
  
  RESULTS
  The CR uptake rate in the entire cohort (n = 35,752) was 11.7%. The uptake rate among patients with an ACS and/or intervention (n = 12,201) was 28.5%, as opposed to 3.0% among patients with CHF or stable AP (n = 23,551). The highest CR uptake rate was observed in patients who underwent cardiac surgery (58.7%). Factors associated with lower CR uptake were female gender, older age, elective PCI (as compared to acute PCI), unstable AP (as compared to myocardial infarction), larger distance to the nearest provider of CR, and comorbidity.
  
  
  CONCLUSIONS
  A minority of Dutch patients eligible for CR received CR. Future implementation strategies should focus on females, elderly patients, patients with unstable AP and/or after elective PCI, patients with long travelling distances to the nearest CR provider, and patients with comorbidities.
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mariëtte
authors.initials: M
authors.lastname: van Engen-Verheul
authors.forename: Han
authors.initials: H
authors.lastname: de Vries
authors.forename: Hareld
authors.initials: H
authors.lastname: Kemps
authors.forename: Roderik
authors.initials: R
authors.lastname: Kraaijenhagen
authors.forename: Nicolette
authors.initials: N
authors.lastname: de Keizer
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000534:rehabilitation; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000453:epidemiology / Q000534:rehabilitation; D000789:Angina, Unstable / Q000453:epidemiology / Q000534:rehabilitation; D002908:Chronic Disease; D015897:Comorbidity; D001026:Coronary Artery Bypass; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D006333:Heart Failure / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors