Researchers: Robert Klempfner, Ilan Goldenberg, Shlomy Matetsky^1,2, Ilan Goldenberg^1,2, Shlomy Matetsky^1.2

Background: cardiac rehabilitation (CR) is a multidisciplinary intervention for secondary prevention of coronary heart disease. Utilization of CR is suboptimal.

Objectives: Characterization of subjects referred to cardiac rehabilitation after myocardial infarction (MI) compared to the non-referred group, assess referral trends 2006-2013 and identify independent predictors for referral and evaluate effect on one-year mortality.

Method: Data was extracted from the ACSIS (Acute Coronary Syndrome in Israel) national surveys, which contain comprehensive clinical information regarding patients admitted with a myocardial infarction. The study included 6,551 patients.

Findings: Referral to CR after MI significantly increased, 2006 only 38% referred vs. 57% in 2013 (p<0.001). Multivariate modeling identified a number of independent predictors for non-referral: 2006 survey, older age, female gender, past stroke or MI, heart or renal failure, prior MI, minorities, and lack of CR center (all p<0.01). Multivariate Cox model demonstrated a significant 29% mortality risk reduction at 1-year (p<0.01).

Conclusions: Several important populations do not receive an equal opportunity to participate in CR programs due to lack of reference. Paradoxically, older patients, with multiple comorbidities and complex conditions, most in need of multidisciplinary program, do not receive this opportunity.

Recommendations: Referral to CR should be encouraged, especially in populations of minorities, women and patients of complex medical backgrounds and comorbidities.
Inclusion CR referral as one of the quality indicators monitored by the ministry of health will greatly increase rate and provide better opportunities to un-referred groups.

Research end date: 12/2020