Attendance at outpatient cardiac rehabilitation: is it enhanced by specialist nurse referral?

Objective: Strength of physician recommendation is the principal predictor of outpatient cardiac rehabilitation (CR) participation. Since nurses spend more time with inpatients than physicians, recommendations by nurses may be significant. This study sought to determine which health care provider recommendations were independently associated with CR attendance. Design and setting: Secondary analysis of cross‑sectional survey data provided by patients discharged between March 1998 and February 1999 with coronary heart disease from public hospitals in the Hunter region of New South Wales. Subjects: Surveys seeking information about advice to attend CR and CR attendance were mailed to 1933 patients aged 20 to 84 years, discharged with a principal diagnosis of acute myocardial infarction, unstable angina pectoris, congestive heart failure, and ischaemic heart disease including those undergoing coronary artery bypass graft surgery and percutaneous coronary intervention. Multiple logistic regression was used to determine which health care provider recommendations were associated with CR attendance. Main outcome measures: Self‑report of one or more health care provider recommendations to attend CR and self‑reported attendance. Results: Among the 404 patients advised to attend CR (70% male, 53% ≥65 years), 66% (266/404) attended at least one session. The odds of attendance were significantly higher among patients referred to CR by a CR nurse after adjustment for strength of physician recommendation and other potential confounding variables (odds ratio 3.40, 95% confidence interval 1.74‑6.64). Conclusions: Since recommendations by CR nurses increased the odds of CR attendance, CR nurse recommendations should be included in strategies designed to increase CR utilisation.