title: Cardiac rehabilitation enrollment among referred patients: patient and organizational factors.
abstract: OBJECTIVE
  Cardiac rehabilitation (CR) is underutilized despite well-documented benefits for patients with coronary heart disease. The purpose of this study was to identify organizational and patient factors associated with CR enrollment.
  
  
  METHODS
  Facilities of the Wisconsin Cardiac Rehabilitation Outcomes Registry (N = 38) were surveyed, and the records of referred patients were analyzed. Generalized estimating equations were used to account for clustering of patients within facilities.
  
  
  RESULTS
  Of the 6874 patients referred to the 38 facilities, 67.6% (n = 4,644) enrolled in CR. Patients receiving coronary artery bypass grafting (adjusted odds ratio [OR], 1.72; 95% CI: 1.36-2.19) and those who possessed health insurance (OR, 3.04; 95% CI: 2.00-4.63) were more likely to enroll. Enrollment was also positively impacted by organizational factors, including promotion of CR program (OR, 2.35; 95% CI: 1.39-4.00), certification by the American Association of Cardiovascular Pulmonary Rehabilitation (OR, 2.63; 95% CI: 1.32-5.35), and a rural location (OR, 3.30; 95% CI: 2.35-4.64). Patients aged ≥65 years (OR, 0.81; 95% CI: 0.74-0.90) and patients with heart failure (OR, 0.40; 95% CI: 0.22-0.72), diabetes (OR, 0.58; 95% CI: 0.37-0.89), myocardial infarction without a cardiac procedure (OR, 0.78; 95% CI: 0.67-0.90), previous coronary artery bypass grafting (OR, 0.72; 95% CI: 0.56-0.92), depression (OR, 0.56; 95% CI: 0.36-0.88), or current smoking (OR, 0.59; 95% CI: 0.44-0.78) were less likely to enroll.
  
  
  CONCLUSIONS
  Predictors of patient enrollment in CR following referral included both organizational and personal factors. Modifiable organizational factors that were associated either positively or negatively with enrollment in CR may help directors of CR programs improve enrollment.
authors.affiliation: Brandeis University, Waltham, Massachusetts (Drs Turk-Adawi, Stason, and Shepard); Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin (Dr Oldridge); and Division of Biostatistics, Medical College of Wisconsin, Milwaukee (Dr Tarima).
authors.forename: Karam I
authors.initials: KI
authors.lastname: Turk-Adawi
authors.forename: Neil B
authors.initials: NB
authors.lastname: Oldridge
authors.forename: Sergey S
authors.initials: SS
authors.lastname: Tarima
authors.forename: William B
authors.initials: WB
authors.lastname: Stason
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
mesh_terms: D000367:Age Factors; D000368:Aged; D002568:Certification; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000534:rehabilitation*; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008389:Marketing of Health Services; D009203:Myocardial Infarction / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D012047:Rehabilitation Centers; D019035:Rural Health Services; D012907:Smoking / Q000453:epidemiology; D014922:Wisconsin / Q000453:epidemiology