Predictors of Cardiac Rehabilitation Participation in Older Coronary Patients

TLDR

Older coronary patients have lower exercise capacity and are less likely to be referred to outpatient cardiac rehabilitation compared to younger patients. This study aimed to identify demographic, medical, and psychosocial predictors of cardiac rehabilitation participation among hospitalized older post‑coronary patients. Researchers conducted in‑hospital guided interviews with 226 patients aged 62 and older who had recently experienced myocardial infarction or coronary bypass surgery, collecting demographic, medical, and psychosocial data for analysis. Only 21% of the cohort enrolled in cardiac rehabilitation; the strongest predictor was the primary physician’s recommendation, with commute time, denial of illness severity, and history of depression also significant, while cardiac diagnosis and ejection fraction were not predictive. Published in Arch Intern Med.

Abstract

<h3>Background.—</h3> While older coronary patients have a lower exercise capacity than younger coronary patients and have been demonstrated to improve exercise capacity to a degree similar to younger coronary patients, they are less likely to be referred to an outpatient cardiac rehabilitation program. The goal of this study was to determine demographic, medical, and psychosocial predictors of outpatient cardiac rehabilitation participation in hospitalized older post—coronary event patients. <h3>Methods.—</h3> An in-hospital—guided interview was performed by the clinical research nurse of the cardiac rehabilitation program with 226 hospitalized patients, aged 62 years and older, who had recently suffered a myocardial infarction or coronary bypass surgery. Demographic, medical, and psychosocial data were analyzed. <h3>Results. —</h3> Overall cardiac rehabilitation participation rate in a population with a mean age of 70.4±6 years (range, 62 to 92 years) was 21%. By multivariate analysis, the strength of the primary physician's recommendation for participation was the most powerful predictor of cardiac rehabilitation entry. Also, significant predictors of participation included commute time, patient "denial" of severity of illness, and history of depression. Medical factors such as cardiac diagnosis and left ventricular ejection fraction did not predict participation. <h3>Conclusions.—</h3> Demographic, medical, and psychosocial data, collected in hospitalized post—coronary event patients are powerful predictors of subsequent participation in cardiac rehabilitation. (<i>Arch Intern Med.</i>1992;152:1033-1035)