northwest ontario has higher rates of cardiac hospitalization compared to southern ontario for reasons not fully understood. however, cardiac rehabilitation (cr), a proven secondary prevention strategy, remains underutilized in northwest ontario. this study therefore aims to evaluate cr utilization and factors that impact access to cr. we also examined how cr may impact cardiac-related rehospitalization in northwest ontario. methods: a retrospective cohort study was selected to analyze patients discharged with a cardiac-related index event at the thunder bay regional health sciences centre (tbrhsc) between july 2014 and december 2017 and subsequently followed until february 2023. binary logistic regression and cox proportional hazards models were used to identify factors influencing cr referral, enrollment, completion, and time to cardiac-related rehospitalization. findings: of the 448 eligible patients, 93.1% were referred to cr, of those only 51.7% enrolled, and of those that enrolled about 41.9% completed the program. the overall completion rate from the 448 eligible patients was therefore 19.9%. enrollment was positively associated with having a partner (or=3.14, p<0.01) and being female (or=2.06, p<0.01) and negatively with drive time (or=0.97, p=0.03). a family history of heart disease was the only factor associated with cr completion (or=2.18, p=0.02). cr completion delayed time to rehospitalization (hr=0.69, p=0.05), with a 31% lower risk of rehospitalization among those completing cr in our unadjusted analysis. however, after adjusting for covariates, this impact became non-significant. conclusion: although referral rates are high due to a systematic process at the tbrhsc, cr enrollment and completion in northwest ontario remain suboptimal. barriers include gender disparities and geographic accessibility. while completing cr appears to reduce cardiac-related rehospitalization, the overall impact on mitigating the cardiovascular disease burden in northwest ontario may be limited due to low cr completion rates. further research is needed to quantify the long-term benefits of cr completion and identify strategies to improve completion rates in this region.