Cardiac rehabilitation services in New Zealand: access and utilisation

Abstract

Aim: To identify factors associated with patient referral to, uptake of, and completion of cardiac rehabilitation programmes in New Zealand.

Methods: Information was collected on referrals to cardiac rehabilitation during February 2002. Routinely collected hospitalisation data were obtained for men and women aged over 35 years with specified coronary episodes. The data were merged, and four predictive logistic regression models developed.

Results: There were 2001 people either hospitalised or referred to cardiac rehabilitation. Of the 1696 hospitalised, 36% were referred for rehabilitation. After adjusting for ethnicity, women were less likely to be referred: odds ratio (OR)=0.72 [95% confidence interval (CI) 0.57-0.91]. With each 10-year age increase, there was a lower likelihood of referral (OR=0.74; 95%CI 0.67-0.82). Of those people who were referred to inpatient rehabilitation, 83% were referred to an outpatient programme. Lack of access to transport was associated with reduced likelihood of referral (OR=0.44 95%; CI 0.28-0.70) and with attendance (OR=0.54; 95%CI 0.33-0.88). Those who had previously attended a cardiac rehabilitation programme were significantly more likely to attend, and compared to those aged 65 to 74 years, those older or younger were less likely to complete the programme. Some associations with deprivation were found, but none with ethnicity.

Conclusion: This study demonstrated considerable scope for improvement in referral to, uptake of and completion of cardiac rehabilitation programmes in New Zealand. It highlighted the need to improve referral processes, promotion, provision, delivery and monitoring of cardiac rehabilitation services.