Gender differences in the factors predicting initial engagement at cardiac rehabilitation

Objective To determine whether there are gender differences in the factors that predict attendance at the initial cardiac rehabilitation baseline assessment (CR engagement) after referral. Methods Using data from the National Audit of Cardiac Rehabilitation, we analysed data on 95,638 patients referred to CR following a cardiovascular diagnosis/treatment between 2013 and 2016. Eighteen factors that have been shown in previous research to be important predictors of CR participation were investigated and grouped into four categories: socio-demographic factors, cardiac risk factors, patient medical status and service-level factors. Logistic binary regression models were built for male patients and female patients, assessing the likelihood for CR engagement. Each included predictors such as age, number of comorbidities and social deprivation score. Results There were no important differences in the factors that predict the likelihood of CR engagement in men and women. Seven factors associated with a reduced probability of CR engagement, and eight factors associated with increased probability, were identified. Fourteen of the fifteen factors identified as predicting the likelihood for engagement/non-engagement were the same for both males and females. Increasing age, being South Asian or non-white ethnicity (other than Black), and being single were all associated with a reduced likelihood of attending an initial CR baseline assessment in both men and women. Male patients with diabetes were 11% less likely to engage with CR, however there was no significant association in females. Results showed that the overwhelmingly important determinant of CR engagement observed in both men and women was receiving an invitation to attend an assessment session (OR 4.223 males/ 4.033 females; p value <0.05). Conclusions Consideration of gender differences in predictors of CR uptake should probably be more nuanced and informed by the stage of the patient care pathway.