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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Predictors of Enrollment in Cardiac Rehabilitation Programs in Spain
Saioa Chamosa1, Jose A Alarcón, Miren Dorronsoro
1BioDonostia Institute, Donostia-San Sebastián, Spain (Ms Chamosa); Regional Office for Public Health in Gipuzkoa, Donostia-San Sebastián, Spain (Ms Chamosa); Cardiac Rehabilitation Unit, Department of Cardiology, Donostia University Hospital, Donostia-San Sebastián, Spain (Drs Alarcón, de la Cuesta, and San Vicente); Office of Public Health and Addictions, Basque Government, Vitoria, Spain (Dr Dorronsoro); Research Centre Network for Epidemiology and Public Health (CIBERESP), Barcelona, Spain (Dr Dorronsoro); Cardiac Rehabilitation Unit-Rehabilitation Service, Donostia University Hospital, Donostia-San Sebastián, Spain (Drs Madruga and Barrera); Cardiac Rehabilitation Unit-Clinical Psychology, Donostia University Hospital, Donostia-San Sebastián, Spain (Mr Arrazola); Medical Management of Integrated Healthcare Organization Bidasoa, Bidasoa Hospital, Hondarribia, Spain (Dr Alkiza); Underwriting and Contracting Office of Gipuzkoa, Donostia-San Sebastián, Spain (Dr Begiristain); and Basque Regional Health Department, Donostia-San Sebastián, Spain (Dr Carrera).
Insights
Older age, living alone, and distance to cardiac rehabilitation programs are barriers to patient enrollment. Women with a history of myocardial infarction also face challenges. Improving access and addressing these factors can enhance secondary cardiovascular prevention.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Cardiac rehabilitation (CR) is crucial for secondary prevention of cardiovascular diseases.
- Understanding factors influencing CR program enrollment is vital for improving patient outcomes.
Purpose of the Study:
- To identify population-based factors associated with nonenrollment in cardiac rehabilitation programs.
- To analyze barriers to participation in cardiac rehabilitation for referred patients.
Main Methods:
- Retrospective study of 756 patients referred to a tertiary hospital's cardiac rehabilitation program (CRP) between January 2009 and June 2012.
- Logistic regression analysis was used to assess the relationship between patient characteristics and nonenrollment.
Main Results:
- Out of 756 referred patients, 20.9% did not enroll in CR.
- Factors associated with lower enrollment included older age, living alone, distance >50 km from the CR unit, and for women, a history of myocardial infarction.
- Referral rates were significantly lower for women than men.
Conclusions:
- While referral rates in this setting exceed national averages, there is room for improvement.
- Older age, social isolation, geographical distance, and prior cardiovascular events (in women) are significant barriers to CR program enrollment.
- Targeted interventions are needed to overcome these barriers and increase CR participation for better cardiovascular secondary prevention.
Purpose:
Cardiac rehabilitation (CR) is very effective for secondary prevention of cardiovascular disorders. The objective of this study was to analyze population factors associated with nonenrollment of cardiac patients in these programs.
Methods:
Retrospective study of 756 patients referred to the cardiac rehabilitation program (CRP) of a tertiary referral hospital with a service area population of more than 640 000 from January 2009 to June 2012. We assessed the relationship between population characteristics of these patients and nonenrollment by logistic regression analysis.
Results:
There were 2386 hospital admissions for an acute coronary syndrome during the study period. Out of the 2355 patients who were alive at discharge, 756 (632 men and 124 women) were referred for CR (32.1% vs 3% state average and vs 51% European average). Of these patients, 20.9% did not enroll. The referral rate was lower among women than among men (P < .001). The characteristics associated with a lower rate of enrollment in the program were age (OR: 1.05; 95% CI: 1.02-1.09), living alone (OR: 4.54; 95% CI: 2.53-8.16), living further than 50 km from the CR unit (OR: 2.90; 95% CI: 1.29-6.41) and, in women, having a history of cardiovascular disease (recurrent myocardial infarction) (OR: 6.35; 95% CI: 2.53-11.81).
Conclusions:
The rate of referral for CR in our setting is well above the national average but still could be improved. We identified older age, living alone, travel distance to the cardiac rehabilitation unit, and, in women, a history of a previous myocardial infarction as barriers to enrollment in CRPs.
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