Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend

• Published in: European journal of public health 2008-10, Vol.18 (5), p.479-483
• Main Authors: Nielsen, Kirsten M., Faergeman, Ole, Foldspang, Anders, Larsen, Mogens L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood pressure; Cardiology; Cardiovascular disease; Cohort analysis; Cohort Studies; cohort study; Coronary vessels; Death; Denmark; Denmark - epidemiology; Electrocardiography; Female; Health behavior; Health care; Heart attacks; Heart Diseases; Hospitals; Humans; Internal medicine; Kinases; Laboratories; Male; Medical prognosis; Middle Aged; Mortality; myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Myocardial Infarction - rehabilitation; Patient Compliance; Patients; Public health; Regression analysis; Rehabilitation; Smoking cessation; Social Class; Socioeconomic Factors
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckn060

Background: Cardiac rehabilitation (CR) is well documented, in randomised trials, to reduce mortality risk after myocardial infarction (MI). Selection of healthy patients for CR is a relatively unexplored problem. Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality, re-admission and invasive treatment among CR-attendees as compared to CR-non-attendees. Methods: From a cohort of 138 290 persons aged 30–69 years, we identified consecutive MI patients, between 1 April 2000 and 31 March 2002. There were 206 MI patients, who survived until admission, and among the 200 who survived 30 days, 145 (72.5%) attended a comprehensive CR programme. Data were obtained from patient charts and from Danish population registers, and as a result we had no non-participation for the study. Results: The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8% among CR-attendees and CR-non-attendees, respectively (P < 0.0001). Among CR-non-attendees, there was a smaller fraction having an invasive treatment performed as compared with CR-attendees. By multiple logistic regression controlling for age and sex, CR-attendance was associated with chest pain, whereas CR-non-attendance was associated with low gross income, single living and inverted T-wave in the electrocardiogram. Conclusion: CR attendance rate was 72.5%. Non-attendees have a higher mortality risk, which in part may be attributed to selection of healthy patients. Non-attendees are older and more likely to have atypical symptoms at admission, a low socioeconomic status and to live alone. Special attention is needed to improve CR attendance among such patients.