Factors associated with cardiac rehabilitation attendance: a systematic review of the literature

Background: Many eligible patients fail to attend cardiac rehabilitation courses. Objective: To undertake a systematic literature review of studies that have investigated factors associated with cardiac rehabilitation attendance. Methods: Literature published between 1978 and 2001 was searched using the MEDLINE, PSYCINFO and CINAHL computerized databases. Studies were sought that examined course attendance in eligible patient samples. Studies had to include at least one baseline predictor variable. Results: Fifteen studies were identified and predictor variables were usually categorized as sociodemographic, medical and psychological. Nonattenders are more likely to be older, to have lower income/greater deprivation, to deny the severity of their illness, they are less likely to believe they can influence its outcome or to perceive that their physician recommends cardiac rehabilitation. Job status, gender and health concerns play an indirect role in attendance behaviour. Comparison of results between studies could be influenced by different case-mix, measurement instruments and country of origin. Conclusion: A number of factors predict cardiac rehabilitation attendance and some of these are potentially modifiable.