The European Journal of Public Health Advance Access published online on July 9, 2008
The European Journal of Public Health, doi:10.1093/eurpub/ckn060
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Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend
Kirsten M. Nielsen1, Ole Faergeman1, Anders Foldspang2 and Mogens L. Larsen1
1 Department of Internal Medicine and Cardiology, Aarhus Sygehus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, Denmark
2 Department of Health Services Research, Institute of Public Health, University of Aarhus, Vennelyst Boulevard, 8000 Aarhus C, Denmark
Correspondence: K. M. Nielsen, MD, Department of Internal Medicine and Cardiology, Aarhus Sygehus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, Denmark, tel: +45 8949 7601, fax: +45 8949 7619, e-mail: Melgaard{at}dadlnet.dk
Received December 13, 2007 , accepted June 12, 2008
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.
Keywords: cohort study, myocardial infarction, rehabilitation, socioeconomic factors