title: Availability of, referral to and participation in exercise-based cardiac rehabilitation after heart valve surgery: Results from the national CopenHeart survey.
abstract: BACKGROUND
  As with ischaemic heart disease, cardiac rehabilitation (CR) is recommended for patients undergoing heart valve surgery; recommendations are based on limited evidence. The organization of CR programmes and factors associated with uptake among patients undergoing heart valve surgery have not been studied. This study investigated CR programmes for these patients and factors associated with referral and participation.
  
  
  METHODS
  We distributed two nationwide surveys: one to 37 hospitals and 98 municipalities and one to 742 consecutive patients undergoing heart valve surgery. Data were linked to nationwide registries. We analysed the provision and content of programmes using descriptive statistics, and factors associated with referral and participation using logistic regression analysis.
  
  
  RESULTS
  Coverage of CR programmes for these patients was high, with national programme variation. The overall uptake rate was 52%. Simultaneous CABG was associated with a higher probability of referral to CR (OR 2.02 (95%CI 1.12-3.65)); being unmarried (0.44 (0.27-0.72)) and having TAVI with a lower probability (0.26; 0.13-0.52). The referral pattern varied across administrative regions, with patients in the capital region less likely to be referred (0.22 (0.08-0.57)). Patients with TAVI were less likely to participate (0.29 (0.12-0.70)).
  
  
  CONCLUSIONS
  Despite high national programme coverage, only half the patients post heart valve surgery received CR. Both factors identified at provider- and patient-level influenced uptake and included significant regional variation in referral pattern. Further research into the effect and organization of CR post heart valve surgery is needed.
authors.affiliation: Department of Cardiology, Roskilde Hospital, Roskilde, Denmark Centre for Applied Health Services Research, University of Southern Denmark, Odense, Denmark The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark tbh@regionsjaelland.dk.
authors.forename: Tina B
authors.initials: TB
authors.lastname: Hansen
authors.affiliation: The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors.forename: Selina K
authors.initials: SK
authors.lastname: Berg
authors.affiliation: The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors.forename: Kirstine L
authors.initials: KL
authors.lastname: Sibilitz
authors.affiliation: Institute for Public Health, Aarhus University, Aarhus, Denmark Public Health and Quality Improvement, Central Denmark Region, Viborg, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Søgaard
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Lau C
authors.initials: LC
authors.lastname: Thygesen
authors.affiliation: National Institute of Public Health, Ljubljana, Slovenia.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Yazbeck
authors.affiliation: The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Department of Cardiology, Holbæk Hospital, Holbæk, Denmark.
authors.forename: Ann D
authors.initials: AD
authors.lastname: Zwisler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D003718:Denmark; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006351:Heart Valves / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs; D016017:Odds Ratio; D010349:Patient Compliance; D015397:Program Evaluation; D012017:Referral and Consultation; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac rehabilitation; heart valve surgery; organization; participation; referral; uptake