The use of geographical analysis in assessing the impact of patients' home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study

Abstract

Purpose: Geographical analysis is becoming a powerful tool for evaluating the quality of medical services and acquiring fundamental data for medical decision-making. Using geographical analysis, we evaluated the impact of the distance from patients' homes to the hospital on their participation in outpatient cardiac rehabilitation (OCR).

Methods: All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure, and aortic diseases were advised to participate in an OCR program after discharge. Using the dataset of our cohort study of OCR from 2004 to 2015 (n = 9,019), we used geographical analysis to investigate the impact of the distance from patients' homes to hospital on their participation in our OCR program.

Results: Patients whose road distance from home to hospital was 0-10 km, 10-20 km, and 20-30 km participated more in OCR than those whose road distance was ≧ 30 km (OR 4.34, 95% CI 3.80-4.96; OR 2.98, 95% CI 2.61-3.40; and OR 1.90, 95% CI 1.61-2.23, respectively). Especially in patients with heart failure, the longer the distance, the lesser the participation rate (P < .001).

Conclusions: Using geographical analysis, we successfully evaluated the factors influencing patients' participation in OCR. This illustrates the importance of using geographical analysis in future epidemiological and clinical studies.

Trial registration: UMIN000028435.

Keywords: Cardiac rehabilitation; Geocoding; Geographical information; Mapping.

Fig. 1

Flowchart of patient enrollment

Fig. 2

Patients’ home address and participation in OCR (a) and ROC curves for predicting the participation in OCR (b). A Map showing the home addresses of patients. The mark of the hospital depicts the location of our hospital in Fuchu City in Tokyo. Colored dots indicate the location of home addresses of patients (red: only in-hospital cardiac rehabilitation (non-participation group), blue: participation in outpatient cardiac rehabilitation). b ROC curves of road distance, direct distance, and required time from home to hospital for predicting the participation in OCR. OCR, outpatient cardiac rehabilitation; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; CHF, congestive heart failure; ROC, receiver operating characteristic

Fig. 3

The valuables associated with participation in OCR (a) and dropout from OCR (b). Using a regression model, valuables associated with participation in OCR in all study population (n = 9019) (non-participation in OCR (n = 4812) versus participation in OCR (n = 4207)) (a) and dropout from OCR (n = 930) versus participation in OCR (n = 4207) (b) were analyzed. OCR, outpatient cardiac rehabilitation; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; CHF, congestive heart failure

Fig. 4

The participation rate and dropout rate according to road distance. The participation rate in OCR (a) and dropout rate from OCR (b) according to the road distance from home to hospital in subgroups with cardiovascular diseases. The OCR participation rate and dropout rate according to road distance from patients’ homes to the hospital (< 10 km, 10–20 km, 20–30 km, and ≧ 30 km) were compared using the χ² test to examine the participation rate and dropout rate as the distance increases by 10 km. The logistic analysis adjusted for confounding variables with a quadratic term of distance as a continuous variable was also performed. PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; CHF, congestive heart failure