Risk for Re-Enrollment to Cardiac Rehabilitation: A Retrospective Study of Ontario-Based Cardiac Rehabilitation Programs

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Cardiac rehabilitation program, Cardiovascular disease, Ontario CR program, Quality of life


Cardiac rehabilitation (CR) reduces recurrent cardiac events, and cardiovascular disease-related mortality, and increases overall quality of life among individuals with heart disease. Some participants have recurrent cardiac events and require re-referral to CR; however, it is not known whether the risk for recurrent events can be predicted and possibly mitigated. Thus, the purpose of this study was to describe CR re-referral and subsequent re-enrollment rates and understand the impact of risk factors on the risk of re-enrollment. In this study, data from individuals who were referred to CR (n = 1602) in 2008 and individuals who enrolled (n = 930) at two Southwestern Ontario CR programs over a five-year period were used. CR re-referral was defined as a second event within five years of initial discharge in 2008 that may or may not have resulted in re-enrollment, whereas re-enrollment was defined as a second admission to CR. Time to re-referral and re-enrollment by hospital site was described using the Kaplan Meier method and log-rank test. Of the 930 participants who enrolled (58% of individuals referred to CR), 27 (2.9%) participated in CR a second time. The time of re-enrollment was not influenced significantly by program site (Mean (M)=4.89 years, 95% CI 4.84 - 4.95, p =.75 and M=4.92 years, 95% CI 4.87 - 4.97). Findings suggest that individuals who participate in CR the first time have a low rate of re-enrollment and that Ontario CR programs have a consistent model of care.