Women and cardiac rehabilitation: accessibility issues and policy recommendations

The purpose of this study was to identify whether certain factors related to accessibility can predict women's participation in cardiac rehabilitation (CR). This cross-sectional comparative study used a convenience sample of 370 women cardiac patients who were treated and discharged between April 1, 1995, and September 30, 1995. A self-report instrument and medical record reviews were used to collect data at five hospitals and four CR centers in three midsized cities in northeastern Ohio. Differences between participants and nonparticipants were examined on the groups of variables. Logistic regression showed women's participation in CR to be overwhelmingly determined by physician referral (odds ratio [OR] = 0.000), which was more likely to occur if the patient had CR insurance (OR = 0.73). The probability of compliance with a referral in women with CR insurance and no history of coronary heart disease (CHD) was .89; with no insurance and a history of CHD, the probability of participation was .37. Participation was associated with level of education, coronary artery bypass surgery, and available transportation. We recommend the promotion and encouragement of the use of Clinical Practice Guidelines by physicians, and lower cost and more accessible approaches to CR, such as contracting with managed care, home rehabilitation, and community-based programs.