• Kymberley K Bennett, Andrew J Smith, Kadie M Harry, ClarkJillian M RJMR, Marcia A Waters, Amanda J Umhoefer, Dennis S Bergland, Kalon R Eways, and Elizabeth J Wilson.
• University of Missouri, Kansas City (Drs Bennett and Smith and Mss Harry, Clark, Eways, and Wilson); and Truman Medical Center, Kansas City, Missouri (Dr Smith, Mss Waters and Umhoefer, and Mr Bergland).
• J Cardiopulm Rehabil Prev. 2019 Mar 1; 39 (2): 97-104.

PurposeThis study examined multilevel factors as predictors of cardiac rehabilitation (CR) attendance and adherence among underserved patients at a safety-net hospital (SNH).MethodsParticipants were recruited during hospitalization for a cardiac procedure or event. Participants responded to a questionnaire, and outcome data (including CR attendance and adherence) were extracted from medical records at baseline and 6 mo post-discharge.ResultsData were collected from 171 participants, 92 (53.8%) of whom attended CR. On average, participants completed 24 CR sessions (66.7% adherence) and 40 (43.5%) participants fully adhered to the 36 prescribed sessions. Bivariate comparisons showed that participants who attended CR were more likely to have insurance (P = .002), perceive CR as important (P = .008), believe they needed CR (P = .005), and endorsed fewer barriers to CR (P = .005) than their nonattending counterparts. After controlling for insurance status, a regression analysis to predict attendance revealed only 1 predictor; perceived lack of time (P = .04). Bivariate analyses showed that only 1 clinical factor, treatment during hospitalization, was significantly related to adherence (P = .03). Patients with medical management alone (no revascularization) showed less adherence than their counterparts with revascularization.ConclusionsAlthough access to insurance is a significant predictor of attendance, psychological barriers that are amenable to being addressed by CR staff are also important. Findings suggest that perceived lack of time is important in SNH patient decision making to attend CR. This psychological barrier is a subject on which CR staff can intervene to educate patients about the life expectancy increases and decreased personal health care expenditures because of attendance.

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