55Factors associated with non-attendance at exercise-based cardiac rehabilitation

Abstract

Background: Despite well-established positive effects of exercise-based cardiac rehabilitation (exCR), uptake in patients with myocardial infarction (MI) remains low. The understanding of barriers for attending exCR need to be further explored. Purpose: To identify factors associated with non-attendance at exCR in a large Swedish cohort. Methods: A total of 31 297 patients with MI, mean age 62.4±4, from the SWEDEHEART registry were included during the time period 2010-2016. Comparisons between attenders and non-attenders at exCR were measured at baseline (hospital admission) for each variable, including age, gender, comorbidity, risk factor profile, and type of hospital. Binary logistic regression analyses were performed with non-attendance at exCR at one year follow-up as dependent variable, and with observed variables at baseline as independent. Results: In total, 16 214 (52%) of patients with MI were non-attenders to exCR. Non-attenders were older (p<0.001), more often retired (p<0.001), had more previous disease (diabetes, MI, PCI, CABG, heart failure, stroke, all p-values <0.001), higher body-mass index (p<0.009), reduced left ventricular function (p<0.001) and were more often smokers (p<0.001) at baseline than attenders. Gender was not associated with non-attendance (p=0.058). The strongest predictors of reporting non-attendance at exCR were smoking (yes vs no, OR 1.77), type of hospital (county hospital vs university hospital, OR 1.49), occupational status (sick leave vs employed, OR 1.27), previous disease in terms of PCI, CABG and stroke (yes vs no, OR 1.28, 1.27, 1.36, respectively). Two variables decreased the odds for non-attending exCR; gender (female vs male, OR 0.86), current CABG, STEMI, PCI (yes vs no, OR 0.56, 0.85, 0.81, respectively). Conclusions: Non-attendance at exCR was found to be associated with several important factors with impact on rehabilitation outcomes and prognosis for patients with MI. This knowledge is important to further improve the understanding of barriers to attendance at exCR and in the design of future interventions, aiming to increase attendance.