Predictors of cardiac rehabilitation initiation and adherence in a multiracial urban population

Lili Zhang, Maria Sobolev, Ileana L. Pina, David Z. Prince, Cynthia C. Taub

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Lack of initiation and adherence to cardiac rehabilitation (CR) remains a persistent problem. We sought to examine predictors of initiation, adherence, and completion of CR in a unique, minority predominant, urban population. METHODS: We included all patients who were first-time referred to the outpatient CR program at Montefiore Medical Center between 1997 and 2010. The indications for referral included acute myocardial infarction, coronary artery disease, heart failure, stable angina, and valvular heart disease. Adherence was defined as attendance of at least 18 sessions of CR, and completion was defined as attendance of 36 sessions. Multivariable logistic regression was utilized to examine the predictors of initiation, adherence, and completion of CR. RESULTS: A total of 590 patients were included (43.9% white and 56.1% nonwhite patients). Among 400 patients who initiated CR, 229 patients (57.3%) attended at least 18 sessions and 140 patients (35.0%) completed all sessions. Initiation of CR was less likely in patients who were nonwhite (OR = 0.66; 95% CI: 0.44-0.97; P = .04) and those who lacked insurance (OR = 0.54; 95% CI: 0.29-0.83; P = .04). Older age was associated with better adherence (OR = 1.04; 95% CI: 1.02-1.07; P < .001). Requirement of a copayment (OR = 0.57; 95% CI: 0.37-0.87; P = .01) was associated with poor adherence. CONCLUSION: In a multiracial population, nonwhite patients and those who did not have insurance were less likely to initiate CR. Younger age and requirement of copayment were independent predictors for poor adherence. Increasing medical insurance coverage and eliminating copayment may improve the participation and adherence of CR.

Original languageEnglish (US)
Pages (from-to)30-38
Number of pages9
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Volume37
Issue number1
DOIs
StatePublished - 2017

Fingerprint

Urban Population
Insurance
Cardiac Rehabilitation
Heart Valve Diseases
Insurance Coverage
Stable Angina
Coronary Artery Disease
Outpatients
Referral and Consultation
Heart Failure
Logistic Models
Myocardial Infarction

Keywords

  • Adherence
  • Cardiac rehabilitation
  • Copayment
  • Initiation

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of cardiac rehabilitation initiation and adherence in a multiracial urban population. / Zhang, Lili; Sobolev, Maria; Pina, Ileana L.; Prince, David Z.; Taub, Cynthia C.

In: Journal of Cardiopulmonary Rehabilitation and Prevention, Vol. 37, No. 1, 2017, p. 30-38.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Lack of initiation and adherence to cardiac rehabilitation (CR) remains a persistent problem. We sought to examine predictors of initiation, adherence, and completion of CR in a unique, minority predominant, urban population. METHODS: We included all patients who were first-time referred to the outpatient CR program at Montefiore Medical Center between 1997 and 2010. The indications for referral included acute myocardial infarction, coronary artery disease, heart failure, stable angina, and valvular heart disease. Adherence was defined as attendance of at least 18 sessions of CR, and completion was defined as attendance of 36 sessions. Multivariable logistic regression was utilized to examine the predictors of initiation, adherence, and completion of CR. RESULTS: A total of 590 patients were included (43.9{\%} white and 56.1{\%} nonwhite patients). Among 400 patients who initiated CR, 229 patients (57.3{\%}) attended at least 18 sessions and 140 patients (35.0{\%}) completed all sessions. Initiation of CR was less likely in patients who were nonwhite (OR = 0.66; 95{\%} CI: 0.44-0.97; P = .04) and those who lacked insurance (OR = 0.54; 95{\%} CI: 0.29-0.83; P = .04). Older age was associated with better adherence (OR = 1.04; 95{\%} CI: 1.02-1.07; P < .001). Requirement of a copayment (OR = 0.57; 95{\%} CI: 0.37-0.87; P = .01) was associated with poor adherence. CONCLUSION: In a multiracial population, nonwhite patients and those who did not have insurance were less likely to initiate CR. Younger age and requirement of copayment were independent predictors for poor adherence. Increasing medical insurance coverage and eliminating copayment may improve the participation and adherence of CR.",
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AB - BACKGROUND: Lack of initiation and adherence to cardiac rehabilitation (CR) remains a persistent problem. We sought to examine predictors of initiation, adherence, and completion of CR in a unique, minority predominant, urban population. METHODS: We included all patients who were first-time referred to the outpatient CR program at Montefiore Medical Center between 1997 and 2010. The indications for referral included acute myocardial infarction, coronary artery disease, heart failure, stable angina, and valvular heart disease. Adherence was defined as attendance of at least 18 sessions of CR, and completion was defined as attendance of 36 sessions. Multivariable logistic regression was utilized to examine the predictors of initiation, adherence, and completion of CR. RESULTS: A total of 590 patients were included (43.9% white and 56.1% nonwhite patients). Among 400 patients who initiated CR, 229 patients (57.3%) attended at least 18 sessions and 140 patients (35.0%) completed all sessions. Initiation of CR was less likely in patients who were nonwhite (OR = 0.66; 95% CI: 0.44-0.97; P = .04) and those who lacked insurance (OR = 0.54; 95% CI: 0.29-0.83; P = .04). Older age was associated with better adherence (OR = 1.04; 95% CI: 1.02-1.07; P < .001). Requirement of a copayment (OR = 0.57; 95% CI: 0.37-0.87; P = .01) was associated with poor adherence. CONCLUSION: In a multiracial population, nonwhite patients and those who did not have insurance were less likely to initiate CR. Younger age and requirement of copayment were independent predictors for poor adherence. Increasing medical insurance coverage and eliminating copayment may improve the participation and adherence of CR.

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