Variation in Patient Perceptions of Healthcare Provider Endorsement of Cardiac Rehabilitation

PURPOSE: Cardiac rehabilitation (CR) is significantly underutilized. However, physician endorsement promotes greater patient utilization. This study examined perceptions of provider endorsement by patients (1) of sociodemographic groups who are often less represented in CR and by clinical indication and (2) by type of healthcare provider and place of referral. METHODS: Referred cardiac (N = 1156) inpatients from 11 hospitals across Ontario completed a sociodemographic survey inhospital and a mailed followup survey 1 year later. Respondents self-reported perceived healthcare provider endorsement of CR on a 5-point Likert scale, type of referring healthcare provider, and where the referral was initiated. RESULTS: The overall perceived strength of healthcare provider endorsement to CR was 3.75 +/- 1.15. Patients who perceived greater endorsement were significantly more likely to enrol (OR = 2.07) and attend a greater percentage of CR sessions (P < .001). Student t tests showed that women (P < .01), those older than 65 years (P < .01), with lower annual family income (P < .001), less than high school education (P < .01), who were retired (P < .01), or had lower subjective social status (P < .01) reported significantly lower perceived healthcare provider endorsement of CR than their respective counterparts. Perception of CR endorsement did not differ significantly on the basis of location of referral initiation (P < .05), but those who discussed CR with family doctors (P < .05), cardiologists (P < .05), or cardiac surgeons (P < .01) reported significantly greater endorsement than those discussing CR with nurses. CONCLUSIONS: Given the proven benefits of CR, all healthcare providers are recommended to universally and strongly encourage CR participation among their patients in order to optimize utilization and subsequent recovery.