Non-enrolment and non-completion of cardiac rehabilitation among survivors of out-of-hospital cardiac arrest with ischaemic aetiology: a nationwide register-based cohort study

Background Survival after out-of-hospital cardiac arrest (OHCA) of ischaemic aetiology is increasing, yet access to and completion of cardiac rehabilitation remain uncertain. Aim To investigate non-enrolment in and non-completion of cardiac rehabilitation among OHCA survivors of ischaemic aetiology including temporal trends, and to examine sociodemographic characteristics associated with non-participation and non-completion. Methods This nationwide Danish register-based cohort study included adults surviving ≥30 days after a first-time OHCA between 2019 and 2023. Multivariable logistic regression models were used to examine the association between non- enrolment and non-completion, respectively, and sociodemographic parameters of age, sex, cohabitation, comorbidity, education, and employment. Results A total of 1,684 OHCA survivors were included. Overall, 55% did not enrol in CR, and among those who enrolled, 50% did not complete the programme. Non-enrolment was highest in 2020–2022 (60–62%) and declined to 43% in 2023. Survivors who were retired had higher odds of non-enrolment (OR 1.74, 95% CI 1.42–2.44), whereas higher education (OR 0.76, 95% CI 0.55–0.98) and moderate/severe comorbidity (OR 0.53, 95% CI 0.43–0.65) were associated with lower odds of non-enrolment. No sociodemographic characteristics were significantly associated with non-completion. Conclusion A large proportion of OHCA survivors of ischaemic aetiology either did not enrol in or did not complete cardiac rehabilitation. The findings underscore the need for systematic referral to cardiac rehabilitation after OHCA and more tailored rehabilitation approaches.