title: Predictors of early and late enrollment in cardiac rehabilitation, among those referred, after acute myocardial infarction.
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.
  
  
  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.
authors.affiliation: Emory University School of Medicine, 1462 Clifton Road NE, Suite 502, Atlanta, GA 30322, USA. susmita.parashar@emory.edu
authors.forename: Susmita
authors.initials: S
authors.lastname: Parashar
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Bishop
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Charles F
authors.initials: CF
authors.lastname: Jackson
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Boyden
authors.forename: Laurence
authors.initials: L
authors.lastname: Sperling
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000534:rehabilitation*; D010358:Patient Participation / Q000706:statistics & numerical data*; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D012017:Referral and Consultation; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States