Cardiac rehabilitation: The forgotten intervention

OBJECTIVE: To examine the influence of cardiac patients' demographic and he alth characteristics on physicians' cardiac rehabilitation (CR) referral pr actice and patients' attendance at such programs. DESIGN: A retrospective, systematic review of consecutive health records. SETTING: A tertiary care centre and the two associated CR programs in a Wes tern Canadian city. PATIENTS: One thousand, three hundred and twenty-eight adult patients (21 y ears of age or older) discharged following acute myocardial infarction, per cutaneous transluminal coronary angioplasty (PTCA) and/or coronary artery b ypass graft surgery between September 1, 1996 and August 31, 1997. MAIN RESULTS: There were 1245 surviving patients. Evidence of attendance at a CR program was 28.4%, while audit able evidence of referral to a CR prog ram was 23.9%. Stepwise logistic regression revealed that ability to speak English (OR 9.56) living in a city (OR 3.97) and current smoking (OR 1.51) were associated with an increased likelihood, whereas having a history of c hronic obstructive pulmonary disease or asthma (OR 0.53), being 70 years, o f age or older (OR 0.42), having a current admission for PTCA (OR 0.32) and having a history of neurological or cognitive impairment (OR 0.26) were as sociated with a decreased likelihood of CR attendance. Sex, nature of coron ary artery disease risk factors, incidence of postevent complications and p reevent cardiac status (including New York Heart Association status and num ber of previous events) were not associated with patients' CR attendance. CONCLUSIONS: This study suggests that there is an inconsistent and poorly d ocumented approach to referral of patients to CR programs for reasons that remain unclear. These findings provide a foundation for development and tes ting of enhanced referral mechanisms and of innovative means to provide reh abilitation services to patients who are at risk for not being referred to or attending CR programs.