Cardiac rehabilitation after myocardial infarction: Insights into participation rates and predictors, sex differences and outcomes from a Dutch general hospital

Background: Cardiac rehabilitation (CR) is an effective intervention to reduce major cardiac events following myocardial infarction (MI). Despite strong recommendations, participation in CR remains suboptimal. Especially among vulnerable patients like elderly. This study aims to determine contemporary CR participation rates, predictors of non-participation and sex-specific differences at a Dutch general hospital, while evaluating the impact of CR on major adverse cardiac events (MACE) and mortality. Method: A single-center retrospective cohort study included patients admitted to Diakonessenhuis (Utrecht, Netherlands) from December 2019–June 2022. Information regarding CR participation, patient characteristics (e.g. age, sex, medical history), psychological assessments and the incidence of MACE during follow-up were collected from patient files. Result: Of 271 included patients, 63.5% participated in CR. Predictors of CR participation included younger age and undergoing coronary artery bypass grafting (CABG). Female patients were older (68.8 vs 64.8 years, p = 0.013), had worse scores on psychological questionnaires during CR and showed lower CR completion rates (71.8% vs 82.0%, p = 0.025) compared to men. CR participation was associated with lower all-cause mortality (HR 0.16, 95% CI 0.02–0.78, p = 0.023) during a median follow-up time of 4.1 years. Conclusion: CR participation after MI remains suboptimal. Younger age and CABG are associated with higher participation rates. Female patients show lower CR completion rates and perform worse psychologically. Tailored interventions should address compounded barriers such as older age and possible sex-specific psychosocial burdens.