In the modern era of percutaneous coronary intervention: Is cardiac rehabilitation engagement purely a patient or a service level decision?

Aims: Despite the proven benefits of cardiac rehabilitation (CR), utilization rates remain below recommendation in the percutaneous coronary intervention cohort in most European countries. Although extensive research has been carried out on CR uptake, no previous study has investigated the factors that lead patients to attend the initial CR baseline assessment (CR engagement). This paper attempts to provide new insights into CR engagement in the growing percutaneous coronary intervention population. Methods and results: In total, we analysed data on 59,807 patients who underwent percutaneous coronary intervention during 2013 to 2016 (mean age 65 years; 25% female). Twenty factors were hypothesized to have a direct impact on CR engagement and they were grouped into four main categories; namely socio-demographic factors, cardiac risk factors, medical status and service-level factors. A binary logistic regression model was constructed to examine the association between CR engagement and tested factors. All but one of the proposed factors had a statistically significant impact on CR engagement. Results showed that CR engagement decreases by 1.2% per year of age (odds ratio 0.98) and is approximately 7% lower (odds ratio 0.93) in female patients, while patients are 4.4 times more likely to engage if they receive a confirmed joining date (odds ratio 4.4). The final model achieved 86.6% sensitivity and 49.0% specificity with an area under the receiver operating characteristic curve of 0.755. Conclusion: The present results highlight the important factors of the likelihood of CR engagement. This implies that future strategies should focus on factors that are associated with CR engagement.