Factors Associated With Non-enrollment of Center-Based Cardiovascular Rehabilitation Program Among Transient Ischemic Attack or Mild Stroke Patients

Abstract

Purpose: Cardiovascular rehabilitation programs (CRPs) are effective in secondary stroke prevention, yet the enrollment rate is suboptimal. This study aims to identify demographic and clinical factors and patient-reported reasons for non-enrollment in a center-based outpatient CRP among patients with transient ischemic attack (TIA) or mild stroke. Methods: This mixed-method retrospective chart review was conducted in an outpatient CRP affiliated with a tertiary care hospital in Canada from January 2009 to October 2017. A total of 621 patients with TIA or mild stroke were included. Multiple logistic regression was used to determine the relationship between demographic and clinical predictors with non-enrollment. A thematic analysis of multidisciplinary progress notes was done for the non-enrollment subgroup of patients to understand the patient-reported reasons. Results: The non-enrollment rate was 42%. Travel distance to CRP (OR = 1.024; 95% CI, 1.010-1.038), age (OR = 1.023; 95% CI, 1.004-1.042), and current smoking status (OR = 1.935; 95% CI, 1.230-3.042) were associated with non-enrollment. The patient-reported reasons for non-enrollment were occurrence of new medical events and comorbidities, their perceptions of health and CRP, transportation, work/time conflict, and distance. Conclusions: This study found that patients with TIA or mild stroke who were older, lived farther from the CRP center, or were current smokers were less likely to enroll in a CRP. The present findings may help clinicians identify patients unlikely to enroll in a CRP and allow the implementation of interventions focused on health education and physical activity to improve enrollment. Future research should validate these factors in multiple settings using prospective mixed methods so that interventions can be developed to address non-enrollment in the CRP.

Trends in outpatient rehabilitation practices in Japan: analysis using the National Database of Health Insurance Claims Open Data

“…Accordingly, the current study found a large variation in the percentage of rehabilitation performed according to the region. Studies on cerebrovascular, cardiovascular, and chronic obstructive pulmonary diseases have shown that transportation, motivation, and medical costs are barriers to outpatient rehabilitation 21 , 22 , 23 , 24 ) . Additionally, regional disparities in outpatient rehabilitation may be caused by disparities in disease frequency, patient age, and the number of patients requiring care.…”

Perspectives of cardiac rehabilitation in patients who had a stroke: a protocol for a qualitative study review

“…Therefore, conducting qualitative research related to perspectives of cardiac rehabilitation of patients who had a stroke might help overcome individual barriers, understand if existing cardiac rehabilitation programming meets the needs of the patient after stroke. Existing qualitative studies and mixed-method research have first proven the experience and perception of patients who had a stroke engaging in cardiac rehabilitation, 11 19 29–34however, the findings of a single qualitative study do not adequately represent patients’ perspectives. This study is therefore a meta-integration of existing qualitative studies on patients who had a stroke’perspectives of cardiac rehabilitation, with the objective of analysing patients’ benefits, barriers and facilitating factors of cardiac rehabilitation in order to provide a reference for improving stroke cardiac rehabilitation programmes and promoting patients’ physical and mental health.…”