Predictors of attendance at cardiac rehabilitation after myocardial infarction

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Abstract

Objective: The purpose of this study was to determine predictors of attendance at cardiac rehabilitation after myocardial infarction (MI). Methods: Various demographic, behavioural, and clinical variables were measured during hospitalisation in 288 MI patients. Of these, 263 were available to attend outpatient-based cardiac rehabilitation: 108 actually attended. Results: Multiple logistic regression analyses indicated that nonattenders lived in more deprived areas and were less likely to have paid employment. Nonattenders also registered more symptoms of depression and anxiety and exercised less frequently prior to their MI, although only the last of these variables were predicted in a multivariate model. In terms of clinical status, whether patients had been thrombolysed or not was the strongest predictor of attendance. Conclusions: Attendance at cardiac rehabilitation is not an arbitrary matter. Strategies should be developed for encouraging greater attendance among those not in paid employment, those from deprived areas, and those who exercise infrequently.

Introduction

Rehabilitation programmes have become an increasingly popular facility for coronary heart disease (CHD) patients [1], [2], [3], [4]. Whereas in 1989, the British Cardiac Society located only 90 cardiac rehabilitation programmes in the United Kingdom [2], the most recent survey identified 273 such programmes [4]. Undoubtedly instrumental to this increased provision are early meta-analyses [5], [6] and subsequent trials [7], [8] indicating that those randomised to rehabilitation show reduced cardiac mortality, although it should be conceded that counterexamples exist [9].

In spite of the potential benefits, only a minority of eligible CHD patients in the United Kingdom attend [2]. In practice, middle-aged men with uncomplicated myocardial infarction (MI) would appear to predominate in current rehabilitation provision [10], [11], [12]. However, little systematic attention has been paid to the broader demographic, behavioural, and clinical characteristics of nonattenders [1], although one recent study of a mixed sample of MI and coronary artery bypass graft (CABG) patients reported that nonattenders were less likely to be employed, and less likely to believe their condition was controllable and that their lifestyle may have contributed to their illness [13]. If cardiac rehabilitation is to embrace more eligible patients, it is important to identify exactly what distinguishes those that presently do not attend from those who do. Accordingly, the present study examined the baseline demographic, behavioural, and clinical characteristics that predicted attendance at cardiac rehabilitation following MI.

Section snippets

Patients

Between January 1997 and August 1998, all consecutive patients admitted to the coronary care units at two general hospitals in the West Midlands, who met established criteria for MI were eligible for inclusion in the study. To be diagnosed as having MI, patients had to meet at least two of the three following criteria: typical ischaemic chest pain lasting at least 20 min; presence of new pathological Q-waves on the electrocardiogram (ECG); a peak creatinine phosphokinase (CK) level greater than

Results

Twenty-five patients had died prior to rehabilitation. Of the 263 survivors, 108 attended at least 50% of the cardiac rehabilitation sessions. Of the 155 nonattenders, 153 went to none of the sessions and of the 108 attenders, 82 attended all available sessions. The reasons given for nonattendance or incomplete attendance were: not wishing to attend (n=70); comorbid health problems (n=65); returning to work (n=9); being the main carer for a significant other (n=6); living too far away (n=5).

Discussion

In the present study, 41% of eligible patients attended cardiac rehabilitation, a figure identical to that found in another recent study of cardiac rehabilitation in the United Kingdom [13]. A wide range of baseline demographic, behavioural, and clinical variables predicted attendance at cardiac rehabilitation among MI patients. Nonattenders were more likely to be female, live alone, have no paid employment, and live in more deprived areas. The finding that nonattenders were less likely to be

Acknowledgements

The authors wish to thank the cardiac rehabilitation nurse specialists, Margaret Pritchard, Jacqueline Burke, Jane Stubbley, Sharon Pickerill, and Tracy Onley for their assistance. We are also grateful to the cardiologists at both City Hospital and Sandwell District General Hospital for allowing us access to their patients.

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