Purpose: Cardiac rehabilitation (CR) has beneficial effects for patients surviving a myocardial infarction (MI); however, barriers to CR exist at three levels (lack of information of CR, lack of acceptance of CR, and missing referral to CR). Until now, there is limited knowledge of which level is the most important for barriers to CR, so we conducted a registry to identify main barriers to CR at different levels.
Methods: The Rehab-North registry, a cross-sectional study, enrolled 5742 patients with MI in the period of 2011–2014. A special questionnaire clarified if the patient received information about CR (possible barrier from healthcare), if the patient accepted the offer of CR (possible barrier from patients), and to which CR programme the patient was scheduled (possible barrier from healthcare). Figure 1 illustrates the structure of the registry. We assessed baseline characteristics and flow of patients with 95% confidence intervals (CI) and χ2-tests.
Results: The main reasons not to inform patients of CR were CABG operation (26.2%, 95% CI: 24.4–28.0%) and “transferred” (26.0%, 95% CI: 24.2–27.8%). The main barriers of acceptance of CR were “not interested” (21.4%, 95% CI: 20.0–22.3%) and “healthy lifestyle” (4.5%, 95% CI: 4.0–5.2%). Gender did not influence the number of patients being informed about CR (P=0.43) or patients accepting to participate in CR (P=0.09). Patients referred to in-hospital CR showed different baseline characteristics compared with patients referred to out-of-hospital CR; they were younger (60.2 vs. 66.2 years, P<0.001), more likely to be male (P<0.001), and had a higher educational level (P<0.001).
Conclusion: The Rehab-North registry is a highly-valuable registry of patients with MI providing data to study long-term health consequences of CR with focus on the differentiation between in-hospital CR and out-of-hospital CR, as well as social inequalities.