Demographic and Social Factors Affecting Participation in Cardiac Rehabilitation: A Cross-Sectional Study

Abstract

Background: Since 2019, the private sector cardiac rehabilitation (CR) center has consistently provided rehabilitation services to cardiac patients according to established guidelines. However, participation in these programs remains low worldwide. This study aims to explore demographic and social determinants that influence participation in CR programs. Our goal is to assist healthcare providers in developing effective strategies to encourage greater participation in CR, ultimately leading to improved health outcomes and recovery for patients. Objectives: The objective of this study was to explore the demographic and social determinants that influence participation in CR programs. Methods: This cross-sectional study included 250 cardiovascular patients who were referred to the Noor Heart Clinic in Rasht, Iran, for CR over the course of one year. The inclusion criteria required that patients be referred by cardiologists for specific conditions such as stable angina, coronary angioplasty, heart surgery, heart failure, or heart transplant. Patients were excluded if they had incomplete information and refused to participate. Data collection encompassed demographic information (age, gender, education level, place of residence, smoking status, and supplementary insurance), anthropometric measurements (weight and height), past medical history (hypertension or diabetes) and familial history. Psychological factors were evaluated using the Hospital Anxiety and Depression Scale (HADS) to assess symptoms of anxiety and depression. To explore the reasons for non-participation in the rehabilitation program, follow-up phone calls and discussions with patients were conducted. All data were then entered into SPSS software after undergoing quality control, and statistical analyses were performed. Results: Among 250 cardiac patients referred to the same private sector CR center, 150 participated in CR programs while 100 did not, indicating a participation rate of 60%, with a greater proportion of men participating. The mean age of patients in both groups was similar. Ninety-five percent of the patients who participated in rehabilitation lived in the city, compared to only 63% of those who did not participate, who resided in rural areas. In terms of education, 47% of participating patients held a diploma or university degree, whereas only 14% of non-participating patients had similar educational qualifications, with 86% lacking any diploma. Furthermore, over 95% of those in the rehabilitation program had supplementary insurance, while only 37% of the non-participating patients had such coverage. More than 50% of individuals in both groups had a history of diabetes, high BP, and a family history of heart disease. Additionally, over 80% of patients from both groups were classified as overweight or obese based on Body Mass Index. Regarding psychological factors, approximately one-third of the studied patients experienced moderate to severe depression and anxiety disorders, with these issues being more prevalent in women than in men. When it comes to the reasons for not participating in CR, 59% of patients cited a lack of supplementary insurance as the primary reason. Other reasons included financial constraints (10%), distance from the rehabilitation center (approximately 20%), and the absence of a companion (11%). Notably, concerns about distance and the high cost of participation were more frequently expressed by women than by men. Conclusions: Factors such as gender, place of residence, education, and insurance significantly influence participation in CR with the lack of insurance and distance being the most frequently cited concerns of not participating. Although many patients present with cardiac risk factors, a significant portion still does not participate in CR. By addressing gaps in insurance, reducing financial barriers, improving accessibility to CR services, and making strategies to reduce gender disparities, we can increase participation rates. High prevalence of anxiety and depression among patients underscores the need for enhanced psychological support in CR programs.