IMPORTANCE OF BASE-LINE FUNCTIONAL AND SOCIOECONOMIC-FACTORS FOR PARTICIPATION IN CARDIAC REHABILITATION

Enrollment in cardiac rehabilitation has been reported to improve exer cise capacity, psychological well-being, and survival. However, partic ipation rates are low and the reasons for nonparticipation have not be en adequately defined. The purpose of this study was to evaluate the m ajor correlates of nonparticipation and to examine the lever of partic ipation of patients who stand to benefit most on the basis of preenrol lment functional status and health behaviors. Three hundred ninety-thr ee patients undergoing coronary artery bypass surgery (1) had baseline functional status and quality-of-life data collected, and (2) were re cruited for participation in the Duke Center for Living comprehensive 3-week post-coronary bypass surgery rehabilitation program. Baseline d emographic, clinical, catheterization, functional status, psychologica l status, and health behavior descriptors were analyzed to identify un ivariate and multivariable correlates of a patient's decision to parti cipate in the program. At baseline, most clinical factors were similar in participants (n = 52) and nonparticipants (n = 341), but the nonpa rticipants were more often women (26% vs 12%, p = 0.02), Participants were also more likely to be employed (63% vs 45%, p = 0.02) and had a higher education and income distribution than nonparticipants (both p = 0.001). On 2 separate scares, nonparticipants had significantly more baseline functional impairment than participants (both p = 0.001). In multivariable analysis, the independent correlates of higher particip ation rates were: higher education (college graduates 71% more likely to participate than high school graduates) and better baseline Duke Ac tivity Status Index (patients with mild functional impairment were at least 42% more likely to participate than patients with moderate impai rment). Thus, patients with greater functional impairment and with low er socioeconomic status were disproportionately underrepresented in ou r cardiac rehabilitation program despite active recruitment and a waiv er of direct costs offered to patients who could not afford the progra m. New methods must be devised to provide rehabilitation services to p atients who stand to benefit significantly from them but who are unabl e or unwilling to participate in conventional structured programs.