title: A controlled intervention to increase participation in cardiac rehabilitation.
abstract: BACKGROUND
  Cardiac rehabilitation programs are greatly underutilized.
  
  
  METHODS
  This study was a multicenter interventional controlled cohort study.
  
  
  METHODS
  From cardiothoracic departments of five medical centers, 520 coronary artery bypass graft (CABG) patients (386 men) were enrolled in the control arm and 504 CABG patients (394 men) in the intervention arm of our study. A 1-hour seminar to medical staff on the benefits of cardiac rehabilitation followed the control phase and preceded the intervention phase. Patients in the intervention arm received written and oral explanations on cardiac rehabilitation benefits and eligibility, and a follow-up telephone call 2 weeks after hospital discharge. Patients in both study arms were interviewed in the hospital prior to CABG surgery and in their homes a year later.
  
  
  RESULTS
  Rates of participation in cardiac rehabilitation were 16.5% (86/520) for the control arm and 31.0% (156/504) for the intervention arm (p < 0.001). Factors strongly associated with participation in cardiac rehabilitation were: belonging to the intervention arm (OR: 2.06 95% CI: 1.46-2.90, p < 0.0001), male sex, average or above average income, sports related physical activity before surgery, younger age and BMI > 30 kg/m(2). Particularly high increases in participation rates following the implementation were observed among subpopulations of 10 years or less education and those reporting below average income. "Lack of knowledge" regarding cardiac rehabilitation was the reason most commonly stated for not participating in a cardiac rehabilitation program.
  
  
  CONCLUSIONS
  Participation in cardiac rehabilitation almost doubled following a low cost intervention with significant effects on subpopulations that have been underrepresented in cardiac rehabilitation programs.
authors.affiliation: Unit for Cardiovascular Epidemiology, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel Division of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel RachelD@gertner.health.gov.il.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dankner
authors.affiliation: Division of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Drory
authors.affiliation: Unit for Cardiovascular Epidemiology, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Geulayov
authors.affiliation: Department for Data Management, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Arnona
authors.initials: A
authors.lastname: Ziv
authors.affiliation: Unit for Biostatistics, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ilya
authors.initials: I
authors.lastname: Novikov
authors.affiliation: The Department of Cardiothoracic Surgery - Carmel Medical Center - The Technion, I.I.T, Haifa Israel.
authors.forename: Amnon Y
authors.initials: AY
authors.lastname: Zlotnick
authors.affiliation: Department of Cardiothoracic Surgery, Assuta Medical Center, Tel-Aviv Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Moshkovitz
authors.affiliation: Department of Cardiothoracic Surgery, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Elami
authors.affiliation: Cardiac Rehabilitation Institute, Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwammenthal
authors.affiliation: Division of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
mesh_terms: D000367:Age Factors; D000368:Aged; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance; D010353:Patient Education as Topic; D016730:Program Development; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Educational; cardiac rehabilitation; coronary artery bypass surgery; intervention; multicenter study