Cardiac rehabilitation: socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited

Objective-To identify factors associated with the uptake of cardiac rehabil itation following acute myocardial infarction. Design-Retrospective analysis using multivariate logistic regression modell ing. Setting-Two large teaching hospitals in Nottingham. Patients-Cohorts of patients admitted with acute myocardial infarction in 1 992 and 1996. Interventions-None Main outcome measures-Factors in multivariate analysis found to be associat ed with attendance at cardiac rehabilitation. Use of secondary prevention i n those who were and were not invited and those who did and did not attend cardiac rehabilitation. Results-58% of all patients were offered cardiac rehabilitation. Attendance rates were 60% in 1992 and 74% in 1996. Invitations were more likely to be offered to younger patients, those who had received thrombolysis, and to p atients admitted to one of the two Nottingham hospitals. Use of secondary p revention was only 48% in 1992 but this increased to 80% in 1996. Patients not receiving secondary prevention were less likely to be invited to cardia c rehabilitation. Social deprivation was the only factor significantly asso ciated with poor uptake of cardiac rehabilitation in both years. There was no difference in the use of secondary prevention between those who did and did not attend cardiac rehabilitation. Conclusion Those invited to attend a cardiac rehabilitation programme are l ikely to be in a good prognosis group, comprising those who are young and h ave received thrombolysis. Those at greatest risk, particularly patients fr om socially deprived areas, seem to be missing out on the potential benefit s of cardiac rehabilitation. High risk patients should be specifically targ eted to ensure that they are invited to, and encouraged to, attend a progra mme of cardiac rehabilitation.