56Impact of cardiac rehabilitation referral at hospital discharge on 1 year outcome of patients with acute myocardial infarction

Background: Participation in cardiac rehabilitation (CR) has been shown to decrease mortality following acute myocardial infarction (MI), but its impact on rehospitalizations requires examination. Methods: We included patients who were hospitalized with first-ever MI in Olmsted County Minnesota from 1987-2010 and survived to hospital discharge. Participation in CR within the first 30 days following MI was determined using billing data and was analyzed as a time-dependent covariate. The association between CR participation and all-cause rehospitalization was analyzed using Andersen-Gill models to account for repeated events. As CR participation is a non-randomized intervention, we adjusted for propensity to participate after fitting a logistic regression model using 13 factors significantly associated with participation on univariate analysis. Patients were censored at the time of death or last follow-up. Results: Among 2991 patients (mean age 67 years, 59% male, 31% ST elevation MI), 1480 (49%) participated in CR following acute MI hospital discharge (first session occurred at a mean of 9 days post-discharge). Most patients (75%) were rehospitalized at least once during a mean follow-up of 7.6 years, and CR participation was associated with reduced risk of rehospitalization. The rehospitalization rates were 39% and 59% at one year for participants and non-participants, respectively. In unadjusted analysis, CR participation was associated with a markedly decreased risk of rehospitalization (HR 0.51, 95% CI 0.49-0.53, p<0.001). After adjusting for propensity to participate, the association between CR participation and all-cause rehospitalization persisted (HR 0.70, 95% CI 0.67-0.73, p<0.001). Conclusions: CR participation is associated with a markedly reduced risk of rehospitalization after incident MI. In addition to reducing mortality, improving CR participation rates may have a large impact post-MI healthcare resource use.

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Regional Clinical Alliance Path and Cardiac Rehabilitation After Hospital Discharge for Acute Myocardial Infarction Patients in Japan　– A Nationwide Survey –

Circulation Journal ◽

10.1253/circj.cj-15-1392 ◽

2016 ◽

Vol 80 (8) ◽

pp. 1750-1755 ◽

Cited By ~ 8

Author(s):

Tetsuo Arakawa ◽

Leon Kumasaka ◽

Michio Nakanishi ◽

Masatoshi Nagayama ◽

Hitoshi Adachi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Rehabilitation ◽

Hospital Discharge ◽

Nationwide Survey

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See You in 7: improving acute myocardial infarction follow-up care

BMJ Open Quality ◽

10.1136/bmjoq-2017-000296 ◽

2018 ◽

Vol 7 (2) ◽

pp. e000296

Author(s):

Alex Batten ◽

Cassie Jaeger ◽

David Griffen ◽

Paula Harwood ◽

Karen Baur

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Rehabilitation ◽

Hospital Discharge ◽

Recovery Process ◽

Appointment Scheduling ◽

Academic Medical Centre ◽

Number Of Patients ◽

Follow Up Care

Acute myocardial infarction (AMI) follow-up care is a crucial part of the AMI recovery process. The American College of Cardiology’s ‘See You in 7 Challenge’ advocates that all patients discharged with a diagnosis of AMI have a cardiac rehabilitation referral made and outpatient cardiac rehabilitation appointment scheduled to occur within 7 days of hospital discharge. A streamlined AMI cardiac rehabilitation referral and appointment scheduling process was not in place at this urban academic medical centre. To develop the streamlined processes, a Six Sigma project was initiated. Four months before the intervention, 1/38 patients with AMI (2.6%) were scheduled to have the initial outpatient cardiac rehabilitation appointment occur within 7 days of hospital discharge, with an average 18.7 days from hospital discharge to the scheduled initial outpatient cardiac rehabilitation appointment. To reduce the time to this initial appointment, availability of outpatient cardiac rehabilitation appointments was increased, additional staff were trained in appointment scheduling and insurance verification processes and appointments were scheduled prior to hospital discharge. After intervention, the number of patients scheduled to attend an outpatient cardiac rehabilitation appointment within 7 days of hospital discharge improved to 72/79 (91.1%) (two-proportion test, p<0.001). Days from hospital discharge to first scheduled outpatient cardiac rehabilitation appointment were reduced from 18.7 days to 6.3 days (a 66.3% reduction) (Mann-Whitney U test, p<0.01). Initial outpatient cardiac rehabilitation attendance within 7 days of hospital discharge increased from 1/38 (2.6%) to 42/79 (53.2%) (a 50.6% increase) (two-proportion test, p<0.001).

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Clinical characteristics of patients on cardiac rehabilitation program after acute myocardial infarction and evaluation of proper prescribing of cardiac medication at hospital discharge

Opsta medicina ◽

10.5937/opmed1501031m ◽

2015 ◽

Vol 21 (1-2) ◽

pp. 31-40

Author(s):

Jelena Miljkovic

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Rehabilitation ◽

Hospital Discharge ◽

Clinical Characteristics ◽

Rehabilitation Program ◽

Cardiac Rehabilitation Program ◽

Cardiac Medication

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Participation in Cardiac Rehabilitation Programs Among Older Patients After Acute Myocardial Infarction

JAMA Internal Medicine ◽

10.1001/jamainternmed.2015.3819 ◽

2015 ◽

Vol 175 (10) ◽

pp. 1700 ◽

Cited By ~ 43

Author(s):

Jacob A. Doll ◽

Anne Hellkamp ◽

P. Michael Ho ◽

Michael C. Kontos ◽

Mary A. Whooley ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Rehabilitation ◽

Older Patients ◽

Rehabilitation Programs

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CLINICAL OUTCOMES OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER PERCUTANEOUS CORONARY INTERVENTION AMONG CARDIAC REHABILITATION AND NON CARDIAC REHABILITATION GROUPS-A PROSPECTIVE OBSERVATIONAL STUDY

10.36106/gjra/1900954 ◽

2021 ◽

pp. 25-27

Author(s):

Saroj Mandal ◽

Vignesh. R ◽

Sidnath Singh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Observational Study ◽

Cardiac Rehabilitation ◽

Prospective Observational Study ◽

Coronary Intervention ◽

Cardiac Mortality ◽

Percutaneous Coronary ◽

All Cause Mortality

OBJECTIVES To determine clinical outcome and to nd out the association between participation of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in cardiac rehabilitation programme. DESIGN A Prospective observational study. STUDY AREA : Department of Cardiology, Institute of Postgraduate Medical Education and Research,Kolkata. PARTICIPANTS: Patients aged ≥18 years who underwent PCI due to AMI. OUTCOME MEASURES The outcomes were subsequent myocardial infarction, revascularisation, all-cause readmission, cardiac readmission, all-cause mortality and cardiac mortality. RESULT: The data of 1107 patients were included and 60.07%% of them participated in CR program. The risks of revascularisation, all cause readmission and cardiac readmission among CR participants were compared. The results of those analysis were consistent and showed that the CR participants had lower allcause mortality ,cardiac mortality,all cause readmission, cardiac admission. However no effect was observed for subsequent myocardial infarction or revascularisation. CONCLUSIONS: It was suggested CR participation may reduce the risk of all-cause mortality ,cardiac mortality, all cause readmission and cardiac admission.

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