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Predictors of cardiac rehabilitation participation in older coronary patients
P A Ades1, M L Waldmann, W J McCann
1Division of Cardiology, University of Vermont College of Medicine, Burlington.
Insights
Physician recommendation strongly predicts outpatient cardiac rehabilitation (CR) entry for older adults post-coronary event. Factors like commute time and denial also influence CR participation, highlighting the need for targeted interventions.
Area of Science:
- Cardiology
- Geriatrics
- Rehabilitation Medicine
Background:
- Older adults post-coronary event exhibit lower exercise capacity but similar improvement potential compared to younger counterparts.
- Despite similar potential, older patients are less frequently referred to outpatient cardiac rehabilitation (CR).
- Understanding predictors of CR participation in this demographic is crucial for improving access and outcomes.
Purpose of the Study:
- To identify demographic, medical, and psychosocial factors influencing outpatient CR participation in hospitalized older adults post-coronary event.
Main Methods:
- In-hospital interviews were conducted with 226 patients aged 62+ post-myocardial infarction or coronary bypass surgery.
- Demographic, medical, and psychosocial data were collected and analyzed.
- Multivariate analysis was employed to determine significant predictors of CR participation.
Main Results:
- The overall CR participation rate was 21% in patients with a mean age of 70.4 years.
- The primary physician's recommendation was the most potent predictor of CR entry.
- Commute time, patient denial of illness severity, and a history of depression also significantly predicted participation.
- Cardiac diagnosis and left ventricular ejection fraction did not predict participation.
Conclusions:
- Demographic, medical, and psychosocial factors are powerful predictors of CR participation in hospitalized older adults post-coronary event.
- Physician recommendation is a key driver for CR entry.
- Addressing factors like patient perception and psychosocial history may enhance CR uptake in older populations.
Background:
While older coronary patients have a lower exercise capacity than younger coronary patients and have been demonstrated to improve exercise capacity to a degree similar to younger coronary patients, they are less likely to be referred to an outpatient cardiac rehabilitation program. The goal of this study was to determine demographic, medical, and psychosocial predictors of outpatient cardiac rehabilitation participation in hospitalized older post--coronary event patients.
Methods:
An in-hospital-guided interview was performed by the clinical research nurse of the cardiac rehabilitation program with 226 hospitalized patients, aged 62 years and older, who had recently suffered a myocardial infarction or coronary bypass surgery. Demographic, medical, and psychosocial data were analyzed.
Results:
Overall cardiac rehabilitation participation rate in a population with a mean age of 70.4 +/- 6 years (range, 62 to 92 years) was 21%. By multivariate analysis, the strength of the primary physician's recommendation for participation was the most powerful predictor of cardiac rehabilitation entry. Also, significant predictors of participation included commute time, patient "denial" of severity of illness, and history of depression. Medical factors such as cardiac diagnosis and left ventricular ejection fraction did not predict participation.
Conclusions:
Demographic, medical, and psychosocial data, collected in hospitalized post-coronary event patients are powerful predictors of subsequent participation in cardiac rehabilitation.