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PURPOSE: Determinants of outpatient cardiac rehabilitation (CR) use in low- and middle-income countries are not well-known. This study analyzed CR use after coronary bypass surgery by gender and geography and effects of systematic referral, program model, and insurance types on CR participation in the west of Iran.

METHODS: This observational study was conducted in Imam-Ali University Hospital in Kermanshah (KSH), the only CR center in the region (2002-2012). There were 2 CR programs: hospital-based and hybrid (combination of home-based and intermittent hospital-based sessions). Patients were divided into groups who lived inside and outside KSH (O-KSH). Referral, participation, and completion rates and program selection were compared by geography, gender, and insurance types. The effects of systematic referral (as of June 2011) were also analyzed.

RESULTS: Of 4735 patients, 44.6% were referred for, 18.7% enrolled in, and 16.5% completed CR. In KSH compared with O-KSH, referral rates were 58.0% versus 30.7% and participation rates were 27.0% versus 10.2%, respectively (P < .001, in both cases). Participation rate in women was lower than that in men (15.6% vs 20.0%, respectively; P = .001). Systematic referral increased participation, especially in women and O-KSH (P < .001, in both cases). The O-KSH patients and those with unfavorable insurance mostly selected the hybrid program (P < .001, in both cases). Among participants, completion rates based on gender and geography were similar.

CONCLUSIONS: Referral and participation rates of coronary bypass surgery patients in CR were low in the west of Iran, especially in women and O-KSH. Systematic referral along with the hybrid program increased them significantly.

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