Socially differentiated cardiac rehabilitation: can we improve referral, attendance and adherence among patients with first myocardial infarction?
OBJECTIVE
The comprehensive cardiac rehabilitation (CR) programme after myocardial infarction (MI) improves quality of life and results in reduced cardiac mortality and recurrence of MI. Hospitals worldwide face problems with low participation rates in rehabilitation programmes. Inequality in recruitment and participation among low educated and socially vulnerable patients must be addressed to lower inequality in post-MI health. Our aim was to improve referral, attendance, and adherence rates among socially vulnerable patients by systematic screening and by offering a socially differentiated cardiac rehabilitation programme.


METHODS
From 1 September 2002 to 31 December 2005, 388 first-incidence MI patients ≤75 years were hospitalised. Register check for newly hospitalised MI patients, screening interview, and systematic referral were conducted by a project nurse. Patients were referred to a standard rehabilitation programme (SRP). If patients were identified as socially vulnerable, they were offered an extended version of the rehabilitation programme (ERP). Excluded patients were offered home visits by a cardiac nurse. Concordance principles were used in the individualised programme elements. Adherence was registered until the 1-year follow up.


RESULTS
86% were referred to the CR. A large share of elderly patients and women were excluded. The attendance and adherence rates were 80% and 71%, respectively among all hospitalised patients. Among referred patients, the attendance rate was 93%. Patients were equally distributed to the SRP and the ERP. No inequality was found in attendance and adherence among referred patients.


CONCLUSIONS
It seems possible to overcome unequal referral, attendance, and adherence in cardiac rehabilitation by organisation of systematic screening and social differentiation.
Health Promotion and Prevention, Centre of Public Health, Central Denmark Region, Aarhus, Denmark. Lucette.Meillier@stab.rm.dk
Lucette Kirsten
LK
Meillier
Kirsten Melgaard
KM
Nielsen
Finn Breinholt
FB
Larsen
Mogens Lytken
ML
Larsen
D000328:Adult; D000368:Aged; D003718:Denmark; D004522:Educational Status; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation*; D010349:Patient Compliance; D012017:Referral and Consultation / Q000592:standards*; D012847:Single Person; D013315:Stress, Psychological / Q000150:complications; D035862:Vulnerable Populations