Understanding attendance patterns and determinants in cardiac, pulmonary, and ICU rehabilitation/recovery programs: A systematic review and meta-analysis

• Published in: Heart & lung 2025-01, Vol.69, p.51-61
• Main Authors: Boehm, Leanne M., Potter, Kelly, McPeake, Joanne, Shaw, Martin, Su, Han, Jones, Abigail C., Renard, Valerie, Eaton, Tammy L., Boethel, Carl, Butler, Javed, Walden, Rachel Lane, Danesh, Valerie
• Format: Article
• Language: English
• Subjects: Attendance; Cardiac rehabilitation; Cardiac Rehabilitation - methods; Cardiac Rehabilitation - statistics & numerical data; Critical care; Humans; Implementation science; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Lung Diseases - rehabilitation; Post-intensive care syndrome (PICS); Pulmonary rehabilitation; Quality of Life - psychology; Recovery; Systematic review
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2024.09.010

•Attendance rates fluctuated most widely across cardiac rehabilitation (4 % to 95 %), while ICU recovery programs had the least attendance variation (24-82 %).•Cardiac rehabilitation attendance significantly differed by region, but there were no significant differences in attendance rates for pulmonary rehabilitation or ICU recovery programs across international settings.•Individual barriers like transportation and work conflicts, alongside institutional and community-level factors, most influenced attendance rates, highlighting the need for tailored strategies to improve participation. Cardiac, pulmonary, and intensive care unit (ICU) rehabilitation/recovery programs are health promotion interventions designed to improve physical recovery, psychological well-being, and quality of life after acute illness while reducing the risk of adverse events. Identify the difference in attendance rates for patients invited to a cardiac rehabilitation, pulmonary rehabilitation, or ICU recovery program and factors influencing attendance. We conducted a systematic review and meta-analysis by searching PubMed, EMBASE, CINAHL, Web of Science, and manual reference lists from inception to June 3, 2024. We included studies reporting patient attendance rates in eligible programs following acute illness hospitalization. Two team members independently screened articles and extracted data, with a third member reviewing and achieving consensus when necessary. Our main outcomes focused on the proportion of attendance in eligible programs among patients referred. Of 3,446 studies screened, 179 studies (N = 4,779,012 patients) were included across cardiac rehabilitation (n = 153 studies), pulmonary rehabilitation (n = 11 studies), and ICU recovery (n = 15 studies) programs. Pooled attendance rates were 53 % (95 % CI: 48-57 %) for cardiac rehabilitation, 56 % (95 % CI: 42-70 %) for pulmonary rehabilitation, and 61 % (95 % CI: 51-70 %) for ICU recovery programs. Significant attendance heterogeneity was present (cardiac I2=100 %, p < 0.001; pulmonary I2=100 %, p < 0.001; ICU I2=94 %, p < 0.01). Barriers to attendance included transportation, distance, work conflicts, and patient factors (e.g., comorbidities, older age). Facilitators included male gender, younger age, higher education, income, provider recommendations, and flexible scheduling. Individual factors represented the primary domain affecting attendance. The results indicate comparable attendance rates and factors shaping atten