title: Employment Status and Participation in Cardiac Rehabilitation: DOES ENCOURAGING EARLIER ENROLLMENT IMPROVE ATTENDANCE?
abstract: OBJECTIVE
  For patients hospitalized for a cardiac event, an earlier appointment to outpatient cardiac rehabilitation (CR) increases participation. However, it is unknown what effect hastening CR enrollment might have among employed patients planning to return to work (RTW).
  
  
  METHODS
  Using 2 complementary data sets from Henry Ford Hospital (HFH) and Mayo Clinic, we assessed when employed patients eligible for CR anticipated a RTW, the impact of an earlier appointment on CR enrollment, and the effect of employment status on the number of CR sessions attended. Patients at HFH attended CR at either 8 or 42 days (through randomization), whereas Mayo Clinic patients attended 10 days after hospital discharge per standard routines.
  
  
  RESULTS
  Among 148 patients at HFH, 65 (44%) were employed and planned to RTW. Of these, 67% desired to RTW within 1 to 2 weeks, whereas 28% anticipated an RTW within 1 to 3 days. Home financial strain predicted nonparticipation in CR (P < .001) and was associated with an earlier planned RTW. Among 1030 patients at Mayo Clinic, 393 (38%) were employed. Employed (vs nonemployed) patients enrolled in CR 3.3 days sooner (P < .001), but attended 1.6 fewer CR sessions (P = .04). In employed patients from both health systems, an earlier (vs later) appointment to CR did not result in additional exercise sessions of CR.
  
  
  CONCLUSIONS
  Employed patients plan to RTW quickly, in part because of home finances. They also enroll earlier into CR than nonemployed patients. Despite these findings, earlier appointments do not seem to favorably impact overall CR participation.
authors.affiliation: Division of Cardiovascular Medicine (Dr Pack, Ms Valdez-Lowe, Dr Mansour, and Dr Keteyian), Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan; Division of Cardiovascular Diseases (Drs Pack, Squires, and Thomas), Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine (Dr Pack), Baystate Medical Group, Springfield, Massachusetts; and Tufts University School of Medicine (Dr Pack), Boston, Massachusetts.
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.forename: Ray W
authors.initials: RW
authors.lastname: Squires
authors.forename: Claudia
authors.initials: C
authors.lastname: Valdez-Lowe
authors.forename: Mouhamad
authors.initials: M
authors.lastname: Mansour
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
mesh_terms: D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data*; D010351:Patient Discharge; D012189:Retrospective Studies; D062707:Return to Work / Q000523:psychology / Q000706:statistics & numerical data; D016037:Single-Blind Method