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https://hdl.handle.net/2440/134116
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Type: | Journal article |
Title: | Predictors of early and late enrollment in cardiac rehabilitation, among those referred, after acute myocardial infarction |
Author: | Parashar, S. Spertus, J.A. Tang, F. Bishop, K.L. Vaccarino, V. Jackson, C.F. Boyden, T.F. Sperling, L. |
Citation: | Circulation, 2012; 126(13):1587-1595 |
Publisher: | Lippincott Williams & Wilkins |
Issue Date: | 2012 |
ISSN: | 0009-7322 1524-4539 |
Statement of Responsibility: | Susmita Parashar, John A. Spertus, Fengming Tang, Kathy L. Bishop, Viola Vaccarino, Charles F. Jackson ... et al. |
Abstract: | BACKGROUND: Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is a Class I recommendation. Although referral to CR after an AMI has recently become a performance measure, many patients may not participate. To illuminate potential barriers to participation, we examined the prevalence of, and patient-related factors associated with, CR participation within 1 and 6 months after an AMI. METHODS AND RESULTS: We studied 2096 AMI patients enrolled from 19 US sites in the Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery (PREMIER) registry. Analyses were limited to those patients referred for CR at the time of AMI hospitalization. A multivariable, conditional logistic regression model, stratified by hospital, was used to identify sociodemographic, comorbidity, and clinical factors independently associated with CR participation within 1 and 6 months of AMI hospital discharge. Only 29% (419/1450) and 48.25% (650/1347) of AMI patients who received referral for CR participated within 1 and 6 months after discharge, respectively. Women (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.44-0.86), uninsured (OR, 0.39; 95% CI, 0.21-0.71), and patients with hypertension (OR, 0.58; 95% CI, 0.43-0.78) and peripheral arterial disease (OR, 0.43; 95% CI, 0.22-0.85) were less likely to participate at 1 month. At 6 months after AMI, older patients (OR, 0.85 for each 10-year increment; 95% CI, 0.74-0.97), smokers (OR, 0.59; 95% CI, 0.44-0.80), and patients with economic burden (OR, 0.56; 95% CI, 0.38-0.81) were less likely to participate. Caucasians (OR, 1.73; 95% CI, 1.16-2.58) and educated patients (OR, 1.81; 95% CI, 1.42-2.30) were more likely to participate at 6 months. Patients with previous percutaneous interventions were less likely to participate at both 1 and 6 months post-AMI. CONCLUSIONS: Among patients referred for CR post-AMI, participation remains low both at 1 and 6 months after AMI. Because CR is associated with beneficial changes in cardiovascular risk factors and better outcomes after AMI, more aggressive efforts are needed to increase CR participation after referral. |
Keywords: | Healthcare disparities; health outcome assessment (healthcare); myocardial infarction; rehabilitation |
Rights: | © 2012 American Heart Association, Inc. |
DOI: | 10.1161/CIRCULATIONAHA.111.088799 |
Grant ID: | K24HL077506 |
Published version: | http://dx.doi.org/10.1161/circulationaha.111.088799 |
Appears in Collections: | Medicine publications |
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