Cardiac rehabilitation (CR) is the most underutilized evidence-based strategy for secondary prevention among patients with CHD, especially among women and ethnic minorities. The purpose of this study was to describe our CR enrollment rates and reasons for non-enrollment among referred patients and explore differences between gender and ethnic groups.

Methods:

Data were abstracted from our CR database between 1/96 and 3/06 (5625 referrals; 80% inpatient source). Patients were included if they were referred to our CR program with documented CHD (myocardial infarction, stable angina, coronary artery bypass graft, and percutaneous coronary intervention) and resided in our geographic service area. Reasons for excluding records (n = 2904) were: referred to other CR due to geographic distance (53%), no CHD diagnosis (41%), and other not eligible (6%). Enrollment rates were calculated as # patients enrolled/#local eligible patients. Enrollment rates and reasons for not enrolling were compared between men and women overall and after stratification by ethnicity.

Results:

Among the 2721 eligible CR referrals (35% women; 30% Black; mean age 61 +/- 12 yrs), 1071 (39%) enrolled in our CR. Among the 1650 not enrolling, the most common reason was "declined to participate" (51%). Other reasons were no insurance/other financial (13%), unable to contact/failed to keep appointment (11%), transportation/distance (8%), medical (8%), and other/unknown (9%). Enrollment rates were higher for men compared to women overall (41% vs 36%, P = 0.01), but greater for black women compared to white women (42% vs 32%, P < 0.01). More men than women declined to participate (55% vs 43%, P < 0.001) and more women than men cited transportation (12% vs 5%) and medical reasons (11% vs 6%), both P < 0.001. More Blacks than Whites cited insurance/financial reasons among women (18% vs 10%) and men (18% vs 11%), P < 0.01.

Conclusion:

Despite a physician referral, the majority of patients referred did not enroll in CR. This is more evident among women than men. Although logistic reasons for not enrolling were more prevalent among women and Blacks, the most frequent reason for all was "declined to participate". More research is needed to explore reasons for this poor response and develop effective interventions for increasing participation in CR.