title: Observing temporal trends in cardiac rehabilitation from 1996 to 2010 in Ontario: characteristics of referred patients, programme participation and mortality rates.
abstract: OBJECTIVE
  We sought to describe temporal trends in the sociodemographic and clinical characteristics of participants referred to cardiac rehabilitation (CR), and its effect on programme participation and all-cause mortality over 14 years.
  
  
  METHODS
  A large CR centre in Toronto, Canada.
  
  
  METHODS
  Consecutive patients between 1996 and 2010.
  
  
  METHODS
  Referrals received were deterministically linked to administrative data, to complement referral form abstraction. Out-of-hospital deaths were identified using vital statistics. Patients were tracked until 2012, and mortality was ascertained. Percentage attendance at prescribed sessions was also assessed.
  
  
  RESULTS
  There were 29,171 referrals received, of which 28,767 (98.6%) were successfully linked, of whom 22,795 (79.2%) attended an intake assessment. The age of the referred population steadily increased, with more females, less affluent and more single patients referred over time (p<0.001). More patients were referred following percutaneous coronary intervention and less following coronary artery bypass graft surgery (p<0.001). The number of comorbidities decreased (p<0.001). Hypertension increased over time (p<0.001), yet the control of cholesterol steadily improved over time. The proportion of smokers decreased over time (p<0.001). Participation in CR significantly declined, and there were no significant changes in mortality. 3-year mortality rates were less than 5%.
  
  
  CONCLUSIONS
  Characteristics of referred patients tended to reflect broader trends in risk factors and cardiovascular disease burden. Physicians appear to be referring more sociodemographically diverse patients to CR; however, programmes may need to better adapt to engage these patients to fully participate. More complex patients should be referred, using explicit criteria-based referral processes.
authors.affiliation: School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.affiliation: Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Oh
authors.affiliation: Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Marzolini
authors.affiliation: Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tracey
authors.initials: T
authors.lastname: Colella
authors.affiliation: Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada.
authors.forename: Yongyao
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D006298:Health Services Administration / Q000639:trends*; D006331:Heart Diseases / Q000401:mortality* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000458:organization & administration; D012307:Risk Factors
keywords: CARDIOLOGY; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; REHABILITATION MEDICINE