title: Predictors of Enrollment in Cardiac Rehabilitation Programs in Spain.
abstract: OBJECTIVE
  Cardiac rehabilitation (CR) is very effective for secondary prevention of cardiovascular disorders. The objective of this study was to analyze population factors associated with nonenrollment of cardiac patients in these programs.
  
  
  METHODS
  Retrospective study of 756 patients referred to the cardiac rehabilitation program (CRP) of a tertiary referral hospital with a service area population of more than 640 000 from January 2009 to June 2012. We assessed the relationship between population characteristics of these patients and nonenrollment by logistic regression analysis.
  
  
  RESULTS
  There were 2386 hospital admissions for an acute coronary syndrome during the study period. Out of the 2355 patients who were alive at discharge, 756 (632 men and 124 women) were referred for CR (32.1% vs 3% state average and vs 51% European average). Of these patients, 20.9% did not enroll. The referral rate was lower among women than among men (P < .001). The characteristics associated with a lower rate of enrollment in the program were age (OR: 1.05; 95% CI: 1.02-1.09), living alone (OR: 4.54; 95% CI: 2.53-8.16), living further than 50 km from the CR unit (OR: 2.90; 95% CI: 1.29-6.41) and, in women, having a history of cardiovascular disease (recurrent myocardial infarction) (OR: 6.35; 95% CI: 2.53-11.81).
  
  
  CONCLUSIONS
  The rate of referral for CR in our setting is well above the national average but still could be improved. We identified older age, living alone, travel distance to the cardiac rehabilitation unit, and, in women, a history of a previous myocardial infarction as barriers to enrollment in CRPs.
authors.affiliation: BioDonostia Institute, Donostia-San Sebastián, Spain (Ms Chamosa); Regional Office for Public Health in Gipuzkoa, Donostia-San Sebastián, Spain (Ms Chamosa); Cardiac Rehabilitation Unit, Department of Cardiology, Donostia University Hospital, Donostia-San Sebastián, Spain (Drs Alarcón, de la Cuesta, and San Vicente); Office of Public Health and Addictions, Basque Government, Vitoria, Spain (Dr Dorronsoro); Research Centre Network for Epidemiology and Public Health (CIBERESP), Barcelona, Spain (Dr Dorronsoro); Cardiac Rehabilitation Unit-Rehabilitation Service, Donostia University Hospital, Donostia-San Sebastián, Spain (Drs Madruga and Barrera); Cardiac Rehabilitation Unit-Clinical Psychology, Donostia University Hospital, Donostia-San Sebastián, Spain (Mr Arrazola); Medical Management of Integrated Healthcare Organization Bidasoa, Bidasoa Hospital, Hondarribia, Spain (Dr Alkiza); Underwriting and Contracting Office of Gipuzkoa, Donostia-San Sebastián, Spain (Dr Begiristain); and Basque Regional Health Department, Donostia-San Sebastián, Spain (Dr Carrera).
authors.forename: Saioa
authors.initials: S
authors.lastname: Chamosa
authors.forename: Jose A
authors.initials: JA
authors.lastname: Alarcón
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Madruga
authors.forename: Javier
authors.initials: J
authors.lastname: Barrera
authors.forename: Xabier
authors.initials: X
authors.lastname: Arrazola
authors.forename: Patxi
authors.initials: P
authors.lastname: de la Cuesta
authors.forename: Maria-Eugenia
authors.initials: ME
authors.lastname: Alkiza
authors.forename: Jose M
authors.initials: JM
authors.lastname: Begiristain
authors.forename: Iñaki
authors.initials: I
authors.lastname: Carrera
authors.forename: Jesús M
authors.initials: JM
authors.lastname: San Vicente
mesh_terms: D054058:Acute Coronary Syndrome / Q000534:rehabilitation*; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012189:Retrospective Studies; D013030:Spain