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Updated: Nov 30, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Factors Associated With Non-enrollment of Center-Based Cardiovascular Rehabilitation Program Among Transient Ischemic
Guangxia Meng1, Hammad Qazi, Helen Chen
1Secondary Stroke Prevention Clinic, Chronic Disease Management, Southlake Regional Health Centre, University of Waterloo, Waterloo, Ontario, Canada (Ms Meng); and Applied Health Science, University of Waterloo, Waterloo, Ontario, Canada (Drs Qazi and Chen).
Insights
Older age, longer travel distance, and current smoking are barriers to cardiovascular rehabilitation program enrollment for stroke patients. Understanding these factors can improve secondary stroke prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Cardiovascular rehabilitation programs (CRPs) are crucial for secondary stroke prevention.
- Suboptimal enrollment rates in CRPs limit their effectiveness.
- Identifying barriers to CRP enrollment is essential for improving patient outcomes.
Purpose of the Study:
- To identify demographic and clinical factors associated with non-enrollment in outpatient CRPs.
- To understand patient-reported reasons for non-enrollment among transient ischemic attack (TIA) and mild stroke patients.
Main Methods:
- Mixed-method retrospective chart review of 621 TIA/mild stroke patients (2009-2017).
- Logistic regression to identify predictors of non-enrollment.
- Thematic analysis of progress notes for patient-reported reasons.
Main Results:
- The non-enrollment rate was 42%.
- Increased travel distance, older age, and current smoking were significantly associated with non-enrollment.
- Patient-reported barriers included new medical events, health/CRP perceptions, transportation, work/time conflicts, and distance.
Conclusions:
- Older patients, those living farther from the center, and current smokers are less likely to enroll in CRPs.
- Findings can guide interventions to enhance CRP enrollment through targeted health education and physical activity promotion.
- Prospective, multi-center research is needed to validate these findings and develop effective interventions.
Purpose:
Cardiovascular rehabilitation programs (CRPs) are effective in secondary stroke prevention, yet the enrollment rate is suboptimal. This study aims to identify demographic and clinical factors and patient-reported reasons for non-enrollment in a center-based outpatient CRP among patients with transient ischemic attack (TIA) or mild stroke.
Methods:
This mixed-method retrospective chart review was conducted in an outpatient CRP affiliated with a tertiary care hospital in Canada from January 2009 to October 2017. A total of 621 patients with TIA or mild stroke were included. Multiple logistic regression was used to determine the relationship between demographic and clinical predictors with non-enrollment. A thematic analysis of multidisciplinary progress notes was done for the non-enrollment subgroup of patients to understand the patient-reported reasons.
Results:
The non-enrollment rate was 42%. Travel distance to CRP (OR = 1.024; 95% CI, 1.010-1.038), age (OR = 1.023; 95% CI, 1.004-1.042), and current smoking status (OR = 1.935; 95% CI, 1.230-3.042) were associated with non-enrollment. The patient-reported reasons for non-enrollment were occurrence of new medical events and comorbidities, their perceptions of health and CRP, transportation, work/time conflict, and distance.
Conclusions:
This study found that patients with TIA or mild stroke who were older, lived farther from the CRP center, or were current smokers were less likely to enroll in a CRP. The present findings may help clinicians identify patients unlikely to enroll in a CRP and allow the implementation of interventions focused on health education and physical activity to improve enrollment. Future research should validate these factors in multiple settings using prospective mixed methods so that interventions can be developed to address non-enrollment in the CRP.
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