title: Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit.
abstract: Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation.
  
  
  
  Data from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees, using the Huber-White-sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234 736 (81.5%) patients referred to CR, 141 648 enrolled, 97 406 initiated CR, and of those initiating, 37.2% completed a program of ≥8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98-0.99), having a partner (OR 1.31, 95% CI 1.17-1.48), not being employed (OR 0.86, 95% CI 0.77-0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77-0.92), greater anxiety (OR 1.02, 95% CI 1.003-1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42-0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09-2.47).
  
  
  
  CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence-based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized.
authors: Department of Health Sciences, University of York, UK jenny.sumner@york.ac.uk.
authors: Jennifer
authors: J
authors: Sumner
authors: School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada University Health Network University of Toronto, Canada.
authors: Sherry L
authors: SL
authors: Grace
authors: Department of Health Sciences, University of York, UK.
authors: Patrick
authors: P
authors: Doherty
mesh_terms: D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D000072038:Cardiac Rehabilitation / Q000706:statistics & numerical data*; D054869:Clinical Audit; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004651:Employment / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006331:Heart Diseases / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012923:Social Class; D014478:Unemployment / Q000706:statistics & numerical data
keywords: cardiac; cardiac rehabilitation; patient compliance; patient factors; uptake; utilization