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Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit

View Article: PubMed Central - PubMed

ABSTRACT

Background: Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation.

Methods and results: Data from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees, using the Huber–White–sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234 736 (81.5%) patients referred to CR, 141 648 enrolled, 97 406 initiated CR, and of those initiating, 37.2% completed a program of ≥8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98–0.99), having a partner (OR 1.31, 95% CI 1.17–1.48), not being employed (OR 0.86, 95% CI 0.77–0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77–0.92), greater anxiety (OR 1.02, 95% CI 1.003–1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42–0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09–2.47).

Conclusions: CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence‐based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized.

No MeSH data available.


Proportion of patients (%) enrolled and completing CR by IMD quintile. CR indicates cardiac rehabilitation; IMD, Index of Multiple Deprivation. *Enrollment and completion compared in least (IMD quintile 1) vs most (IMD quintile 5) deprived group using χ2. For both tests, P<0.001.
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jah31834-fig-0002: Proportion of patients (%) enrolled and completing CR by IMD quintile. CR indicates cardiac rehabilitation; IMD, Index of Multiple Deprivation. *Enrollment and completion compared in least (IMD quintile 1) vs most (IMD quintile 5) deprived group using χ2. For both tests, P<0.001.

Mentions: As shown in Figure 2, there was a gradient in CR utilization based on degree of social deprivation. For each, those with lesser deprivation utilized CR to a greater degree (P<0.001).


Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit
Proportion of patients (%) enrolled and completing CR by IMD quintile. CR indicates cardiac rehabilitation; IMD, Index of Multiple Deprivation. *Enrollment and completion compared in least (IMD quintile 1) vs most (IMD quintile 5) deprived group using χ2. For both tests, P<0.001.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5121492&req=5

jah31834-fig-0002: Proportion of patients (%) enrolled and completing CR by IMD quintile. CR indicates cardiac rehabilitation; IMD, Index of Multiple Deprivation. *Enrollment and completion compared in least (IMD quintile 1) vs most (IMD quintile 5) deprived group using χ2. For both tests, P<0.001.
Mentions: As shown in Figure 2, there was a gradient in CR utilization based on degree of social deprivation. For each, those with lesser deprivation utilized CR to a greater degree (P<0.001).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation.

Methods and results: Data from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees, using the Huber&ndash;White&ndash;sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234&nbsp;736 (81.5%) patients referred to CR, 141&nbsp;648 enrolled, 97&nbsp;406 initiated CR, and of those initiating, 37.2% completed a program of &ge;8&nbsp;weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98&ndash;0.99), having a partner (OR 1.31, 95% CI 1.17&ndash;1.48), not being employed (OR 0.86, 95% CI 0.77&ndash;0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77&ndash;0.92), greater anxiety (OR 1.02, 95% CI 1.003&ndash;1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42&ndash;0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09&ndash;2.47).

Conclusions: CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence&#8208;based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized.

No MeSH data available.