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Cardiac rehab participation low for older adults after acute MI
Despite evidence demonstrating the benefits of cardiac rehabilitation, the rate of participation is low among older adults in the United States after acute MI, according to data published in JAMA Internal Medicine.
Moreover, the rate of participation was low even among patients who were referred for cardiac rehabilitation after acute MI.
Prior research has indicated that cardiac rehabilitation programs are associated with improved survival after MI, lifestyle improvements, better functional capacity and improved quality of life, according to the study background.
Jacob A. Doll, MD, and colleagues analyzed two databases, the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Registry–Get With the Guidelines and a Medicare database of claims, to identify patients aged 65 years or older who presented with acute MI from 2007 to 2010 (n = 58,269). They evaluated enrollment rates in cardiac rehabilitation programs, rates of completion, and factors separating those who participated and those who did not.
Overall, 62.4% of patients were referred to cardiac rehabilitation upon discharge after acute MI. Of those referred, 32.6% attended at least one cardiac rehabilitation session. Of those not referred, 8.2% attended at least one session, according to the results.
The median number of sessions attended was 26 (interquartile range, 14-35). About one-quarter (24.2%) of patients attended at least 36 sessions, which is the typical length of a program; 8.7% attended fewer than five sessions.
Among the entire cohort, 23.4% of patients attended at least one session and 5.4% attended at least 36 sessions, Doll and colleagues wrote.
Compared with nonparticipants, those who participated in at least one session were more likely to be younger, male, white and nonsmokers. In addition, they were more likely to have fewer comorbidities and more likely to have presented with STEMI.
Patients treated with CABG (48.8%) were more likely to attend at least one session compared with those treated with PCI (36%) or medical management (16.3%), according to the researchers.
“Quality improvement efforts should focus on increasing referral rates but also addressing barriers to attending rehabilitation sessions, such as travel distance, copayments, and lack of coordination between inpatient and outpatient physicians,” Doll, from the division of cardiology of the department of medicine at Duke University and Duke Clinical Research Institute, and colleagues wrote. “Alternative methods of providing cardiac rehabilitation, such as home-based programs, may be needed to improve participation rates.” – by Erik Swain
Disclosure: Doll reports no relevant financial disclosures. See the full study for a list of the other researchers’ relevant financial disclosures.