Neighbourhood income and cardiac rehabilitation access as determinants of nonattendance and noncompletion

Abstract

Background: Despite known benefits of exercise-based cardiac rehabilitation (CR), attendance and completion rates remain low. Our objective was to review attendance and completion of CR overall and by level of neighbourhood income in Saskatoon, Canada and then determine the effect of opening a new CR facility in close proximity to low-income neighbourhoods.

Methods: From January 2007 to December 2011, our retrospective cohort included hospital discharge data, CR attendance, and completion rates, stratified according to neighbourhood income, and adjusted for sex and age.

Results: Residents from low-income neighbourhoods were more likely (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.60-1.94) to be hospitalized for ischemic heart disease (IHD), percutaneous transluminal coronary angioplasty (PTCA), or coronary artery bypass graft (CABG) than residents from high-income neighbourhoods. Among those hospitalized for IHD, PTCA, or CABG, 12.7% attended CR. Patients of low-income neighbourhoods were less likely (OR, 1.58; 95% CI, 1.39-1.71) to attend CR than patients of high-income neighbourhoods. Among those who attended, 66.7% quit before program completion. Participants from low-income neighbourhoods were more likely (OR, 1.38; 95% CI, 0.57-3.50) to not complete CR. In total, only 4.2% of patients hospitalized for IHD, PTCA, or CABG started and completed CR. Expanding access to those living in low-income neighbourhoods did not increase attendance (OR, 1.31; 95% CI, 0.79-2.19) or completion rates (OR, 1.25; 95% CI, 0.23-2.41) to a significant level.

Conclusions: High rates of nonattendance and noncompletion of CR were observed. Living in a low-income neighbourhood was associated with lower rates of attendance and completion. Expanding access to CR did not increase attendance or completion among patients of low-income neighbourhoods to a significant level.