Cardiac Rehabilitation After Percutaneous Coronary Intervention in a Multiethnic Asian Country: Enrollment and Barriers

• Enrollment rate of cardiac rehabilitation in Singapore is lower than that reported in Western countries.
• A large proportion of patients reject cardiac rehabilitation because of busy work schedules or for no specific reason.
• Rate of completion among the patients keen to undergo cardiac rehabilitation was low.

ObjectiveTo determine the enrollment or barriers to cardiac rehabilitation (CR) among Asian patients who have undergone percutaneous coronary intervention (PCI).DesignProspective observational study.SettingDepartment of cardiology at a university hospital.ParticipantsPatients (N=795) who underwent PCI between January 2012 and December 2013 at a tertiary medical institution.InterventionsNot applicable.Main Outcome MeasuresData on enrollment in phase 2 CR and its barriers were collected by dedicated CR nurses.ResultsOf 795 patients, 351 patients (44.2%) were ineligible for CR because of residual coronary stenosis, while 30 patients (3.8%) were not screened because of either early discharge or death. Of the remaining 416 patients (90.8% men; mean age, 55y), 365 (87.7%) declined CR participation and 51 (12.3%) agreed to participate. Of these 51 patients, 20 (39%) did not proceed to enroll and 4 (8%) dropped out, leaving 27 patients (53%) who completed at least 6 sessions of the CR program. The top 3 reasons provided by patients who declined to participate in CR were (1) busy work schedules (37.5%), (2) no specific reason (26.7%), and (3) preference for self-exercise (20.1%). Nonsmokers were more likely to participate in CR (P=.001).ConclusionsCR participation of Asian patients after PCI was found to be lower than that reported in Western countries. The exclusion criteria used in the institution under study differed from those provided by international associations. A busy work schedule was the most common reason for declining CR after PCI.