Abstract 11020: Clinical, Psychosocial and Socioeconomic Predictors of Outpatient Cardiac Rehabilitation Participation: The Atherosclerosis Risk in Communities Study

Introduction:Despite robust evidence of its effectiveness for secondary prevention, cardiac rehabilitation (CR) is underutilized. Understanding individual-level predictors of CR use can guide interventions to boost CR participation.Hypothesis:Clinical, psychosocial and socioeconomic predictors impact CR participation.Methods:We studied 1,255 participants from the ARIC Study with cardiovascular disease (CVD) events eligible for CR (myocardial infarction, coronary revascularization, valve surgery) from data linked to Medicare claims (1991-2015). Predictors including comorbidities, functional status, cognitive function, social support, social network, educational attainment, and household income were ascertained from study visits and annual follow-up at the time point closest to the index CVD event. CR participation was defined as having Current Procedural Terminology codes 93797 and 93798. We examined multiple predictors using logistic regression with the Modified Allen-Cady stepwise backward selection of covariates in addition to age, race, sex, and ARIC center.Results:The mean age was 72.4 (SD 5.2) years (16% Black, 43% women) and 26% participated in CR. In multivariate analyses, variables associated with lower CR participation were income <$12,000 (odds ratio (OR) 0.46 [95% CI 0.24 - 0.89]) vs. >$50,000; < high school education (OR 0.48 [0.27 - 0.86]) vs. graduate/professional education; lowest quartile of cognitive function (OR 0.52 [0.32 - 0.85]) vs. the highest quartile; lowest quartile of social support (OR 0.65 [0.44 - 0.96]) vs. the highest quartile; and current smoking (OR 0.55 [0.31 - 0.96]). Comorbidities and social network were not associated with CR participation.Conclusions:Cognitive function, social support, and SES were robustly associated with CR participation. Efforts to address the gap in CR participation should focus on interventions that support patients with low cognitive function, social supports, and SES.