Temporal Trends and Associated Factors of Inpatient Cardiac Rehabilitation in Patients With Acute Myocardial Infarction: A Community-wide Perspective

PURPOSE: Cardiac rehabilitation (CR) has been shown to be an important therapeutic intervention after the development of acute myocardial infarction (AMI), but historically has been underused. Inpatient CR often represents cardiac patients' first exposure to risk factor modification education and acts as a gateway to outpatient programs. METHODS: The authors performed a longitudinal study of the use of inpatient CR in 5204 Worcester residents hospitalized with validated AMI in seven 1-year periods between 1986 and 1997. RESULTS: The overall rate of referral to inpatient CR was 68%, with a slight decline in use to less than 60% in the authors' most recent study year of 1997. Referred patients were significantly more likely to be younger, male, or enrolled in a health maintenance organization; they were less likely to have a history of heart failure or stroke. They were significantly more likely to receive medications shown to be of benefit in the management of AMI and to undergo cardiac interventional procedures. In 1997, patients participating in inpatient CR were more likely to have documented inpatient counseling about nutrition, exercise, smoking, and stress reduction. DISCUSSION: The results of this multihospital community-wide study suggest relatively stable, but recently decreasing, use of inpatient CR over the past decade. Women and the elderly are underrepresented in these programs. Patients not referred to inpatient rehabilitation were less likely to be prescribed effective cardiac medications and undergo risk factor modification counseling prior to discharge. Further studies are needed to better understand the reasons for patient exclusion from the benefits of inpatient CR.