Using registry data to determine actual cardiac rehabilitation participation after percutaneous coronary intervention
Authors: Hjertvikrem N , Pettersen T R , Drotningsvik I , Isaksen A , Kask A , Staveland E H , Norekval T M 
Published: November 2023

Abstract

Background
Comprehensive cardiac rehabilitation (CR) has proven beneficial effects, and is a class 1A recommendation in European Society of Cardiology guidelines. Still, CR is grossly underused globally. In Norway, few studies on CR participation exist, and the extent to which CR is underused is more uncertain. Using data from national quality registries provides an opportunity to estimate actual CR participation, and whether there are some groups that participate less often than others do.

Aim
To determine actual use of CR, comprehensive or single component, in patients after percutaneous coronary intervention (PCI), with a special attention on women, older people, patients with comorbidities and education level.

Methods
CONCARDPCI is a prospective multicentre cohort study including 1970 patients after PCI at three Norwegian university hospitals during 2017-2019. Socio-demographic characteristics were self-reported during the index hospitalization for PCI. Clinical data were collected from patients’ medical records and the Norwegian Registry on Invasive Cardiology. Data on CR participation were extracted from the Norwegian Control and Payment of Health Reimbursements Database, and measured at 2-, 6- and 12 months after index hospitalisation.

Results
One year after PCI, one out of six patients (16%) had received single- or multicomponent CR. At 2 months, 7% had participated in CR, from 2–6 months, 12% participated in CR and from 6–12 months, 2% participated in CR. Most patients were men (78%) with a mean age of 66 years (SD 11, range 20-96 years). At 6 months, fewer women than men had participated in CR (9% vs. 13%, p=0.020). During the 12 month period, 12% of women and 17% of men participated in CR (p=0.019). The patients participating in CR were significantly younger (60 vs. 67, p&lt;0.001) at all measuring points. A sizeable proportion had previous cardiovascular comorbidities including hypertension (52%) and hypercholesterolemia (47%). Patients with hypercholesterolemia participated significantly less than those without at 2 months (6% vs. 8%, p=0.031) and 6 months (9% vs. 14%, p=0.001). Those with hypertension also participated less than those without at 2 months (5% vs. 9%, p=0.002) and 6 months (9% vs. 15%, p&lt;0.001). Further, 26% had previous PCI, and those with a history of PCI participated less than those with no history at 2 months (3% vs. 9%, p&lt;0.001) and 6 months (6% vs. 14%, p&lt;0.001). Finally, those with a lower educational level participated less at 2 months (primary school 4% vs. college/university 10%, p=0.034) and 6 months (primary school 9% vs. college/university 15%, p=0.050).

Conclusion
Very few patients participated in comprehensive or single component CR. Those with a lower educational level and women participated less often in CR, and the proportion was even lower in patients with comorbidities. New modes of delivery for CR is needed to meet the large group of patients not receiving follow-up according to guidelines.