Background: Cardiac rehabilitation (CR) aims to optimize the recovery of cardiac patients and is covered by the medical insurance. CR is associated with decreased mortality and reduced risk for cardiac event recurrence and is an evidence-based therapy for improving quality of life and cardiovascular risk profile. CR participation rate in Israel increased from 5% in 1997 to ~30% in 2013.
Objective: To evaluate factors associated with patients` participation in CR programs and to examine the perception of CR and referral habits among physicians and nurses in selected Israeli hospitals.
Methods: A cross sectional study was conducted among 387 cardiac patients insured at Maccabi Healthcare Services, firstly diagnosed with myocardial infarction (MI) and/or percutaneous coronary intervention or coronary artery bypass graft (CABG) between January and August 2013. Data were collected from medical records and phone interviews regarding socio demographic and clinical characteristics, perception of health condition and health habits, CR referral and participation. A parallel survey was conducted among 41 physicians and 56 nurses from the cardiothoracic surgery and cardiology departments from Sheba Medical Center and Assuta hospital regarding patients` referral, knowledge and perceptions of CR. Patient participation rate and referral rates by physicians and nurses were evaluated and multivariable regression models were constructed to evaluate factors predicting participation in CR among patients and referral by physicians and nurses.
RESULTS: CR participation rate reported by patients was 38% (95%CI 33-43%). Patients who participated in CR were older (OR=1.04 95%CI 1.01-1.07 per 1 year), more likely to be male (OR=1.89 95%CI 0.92-3.88) veteran Israelis (OR=2.24 95%CI 1.06-4.76), more likely to have undergone CABG surgery prior to the study (OR=5.71 95%CI 1.35-24.12), and more likely to have been referred to CR (OR=12.10 95%CI 6.48-22.59) compared with those who did not participate in CR. Lower odds of participation were found among patients living in northern Israel, following MI and hypertensive patients with ~50% lower odds (95%CI 0.27-0.83). Referral of patients to CR services was reported by 83% of the physicians (95%CI 71-95%) and 84% of the nurses (95%CI 74-94%). Higher odds of referral were found among physicians who are familiar with the position paper of the Israel Heart Society regarding CR services in Israel, and among nurses who expected their patients to be compliant with therapeutic recommendations.
Conclusion: CR participation rate remains low compared to referral rates reported by physicians and nurses, though, these findings do not necessarily represent nationwide participation and referral rates. Additional intervention programs for specific populations should be considered at the national level to further promote CR services and participation in Israel.
