Effect of a Computerized Referral at Hospital Discharge on Cardiac Rehabilitation Participation Rates

One of the effective treatments for patients recovering from acute cardiac illness or surgery is cardiac rehabilitation (CR). CR has proven to be effective to reduce mortality, morbidity, and also to improve the quality of life. The purpose of this review is to present the current status of CR program worldwide as well as to identify a potential approach for further investigation. Literature searching of electronic databases was conducted in several databases including CINAHL, MEDLINE, PsycINFO, and EMBASE, and Google Scholar. CR aims to restore patients with CVD to a state of good health. Each country has different approach in the provision and organization of CR as well as the allocation of resources, which depends on their health policies and politics. The indications for CR also differ between countries, but traditionally CR has been used following acute myocardial infarction (MI). CR programs have been divided into three phases of progression. Hospital-based or supervised site-based programs have been known as the most common model of CR in most countries. The core components of CR include patient assessment, nutritional counselling, exercise training, physical activity counselling, weight management, tobacco cessation, aggressive coronary risk-factor management, and psychosocial management. Despite the apparent benefits of CR in patients with CVD, these programs remain largely underused. The participation rates in the USA, Australia, and Europe are low, estimated at 10-30%. New research areas that explore new ways of CR delivery to improve referral and participation rates are essential.

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The Effect of the Revised Clinical Pathway of Cardiac Rehabilitation on Participation Rates in Patients with Myocardial Infarction: A Retrospective Study

Korean Journal of Adult Nursing ◽

10.7475/kjan.2018.30.5.536 ◽

2018 ◽

Vol 30 (5) ◽

pp. 536

Author(s):

Jae Ung Ko ◽

Goo Joo Lee ◽

Han Mi Kim ◽

Heui Je Bang

Keyword(s):

Myocardial Infarction ◽

Retrospective Study ◽

Cardiac Rehabilitation ◽

Clinical Pathway ◽

Participation Rates

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'I don't know why they don't come': barriers to participation in cardiac rehabilitation

Australian Health Review ◽

10.1071/ah09803 ◽

2010 ◽

Vol 34 (4) ◽

pp. 452 ◽

Cited By ~ 18

Author(s):

Michelle L. DiGiacomo ◽

Sandra C. Thompson ◽

Julie S. Smith ◽

Kate P. Taylor ◽

Lynette A. Dimer ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Health Professionals ◽

Cultural Awareness ◽

Aboriginal People ◽

Aboriginal Health ◽

Health Staff ◽

Participation Rates ◽

Awareness Training ◽

Institutional Barriers ◽

Aboriginal Australians

Objectives. To describe health professionals’ perceptions of Aboriginal people’s access to cardiac rehabilitation (CR) services and the role of institutional barriers in implementing the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples. Design. Qualitative study. Setting. Metropolitan and rural tertiary and community-based public CR services and Aboriginal health services in WA. Participants. Thirty-eight health professionals working in the CR setting. Method. Semistructured interviews were undertaken with 28 health professionals at public CR services and 10 health professionals from Aboriginal Medical Services in WA. The participants represented 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services. Results. Emergent themes included (1) a lack of awareness of Aboriginal CR patients’ needs; (2) needs related to cultural awareness training for health professionals; and (3) Aboriginal health staff facilitate access for Aboriginal patients. Conclusions. Understanding the institutional barriers to Aboriginal participation in CR is necessary to recommend viable solutions. Promoting cultural awareness training, recruiting Aboriginal health workers and monitoring participation rates are important in improving health outcomes. What is already known about this subject? Significant health and social inequity exists for Aboriginal Australians. Despite the persisting high rates of morbidity and mortality related to cardiovascular disease in Aboriginal Australians, participation rates in cardiac rehabilitation remain low. What does this paper add? Despite widespread dissemination of NHMRC guidelines, there remains a disconnect between CR health professionals’ understandings and practices and the needs of Aboriginal people in WA. Increasing the volume and quality of cultural awareness training as well as access to Aboriginal health professionals are crucial in addressing this disparity. What are the implications for practitioners? Increasing the number and support of Aboriginal people trained as health professionals will assist the system to respond better to the needs of communities. Collaborative partnership models where Aboriginal and non-Aboriginal health professionals work together to increase mutual understanding are warranted.

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Nurse involvement in cardiac rehabilitation prior to hospital discharge

Journal of Clinical Nursing ◽

10.1111/j.1365-2702.1995.tb00041.x ◽

1995 ◽

Vol 4 (6) ◽

pp. 390-396 ◽

Cited By ~ 23

Author(s):

ANDREW J. NEWENS ◽

SENGA BOND ◽

JONATHAN PRIEST ◽

ELAINE McCOLL

Keyword(s):

Cardiac Rehabilitation ◽

Hospital Discharge

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Participation Rates, Process Monitoring, and Quality Improvement Among Cardiac Rehabilitation Programs in the United States

Journal of Cardiopulmonary Rehabilitation and Prevention ◽

10.1097/hcr.0000000000000108 ◽

2015 ◽

Vol 35 (3) ◽

pp. 173-180 ◽

Cited By ~ 19

Author(s):

Quinn R. Pack ◽

Ray W. Squires ◽

Francisco Lopez-Jimenez ◽

Steven W. Lichtman ◽

Juan P. Rodriguez-Escudero ◽

...

Keyword(s):

United States ◽

Quality Improvement ◽

Cardiac Rehabilitation ◽

Process Monitoring ◽

The United States ◽

Participation Rates ◽

Rehabilitation Programs

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Predicting Long-Term Mortality, Morbidity, and Survival Outcomes Following a Cardiac Event: A Cardiac Rehabilitation Study

Rehabilitation Process and Outcome ◽

10.1177/1179572719827610 ◽

2019 ◽

Vol 8 ◽

pp. 117957271982761 ◽

Cited By ~ 2

Author(s):

Helen L Graham ◽

Andrew Lac ◽

Haeok Lee ◽

Melissa J Benton

Keyword(s):

Cardiac Rehabilitation ◽

Hospital Readmission ◽

Cardiac Event ◽

Bypass Graft ◽

Survival Outcomes ◽

Prior History ◽

Participation Rates ◽

All Cause Mortality ◽

History Of

Background: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity but estimations vary. While there is significant literature supporting short-term benefits, there is not a similarly body of research as to long-term (LT) benefits. Low participation rates in CR are due to several causes and evidence demonstrating positive LT outcomes could be a catalyst to increased participation rates. Objective: To predict LT mortality, readmission, and survival benefits associated with CR participation in a nationally certified program. Methods: Investigators collected mortality and hospital readmission data in a retrospective study to examine a cohort of cardiac patients following a myocardial infarction (MI), MI/percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) up to 14 years ago. Hospital electronic medical record (EMR; n = 207) were used to measure hospital readmission outcome and State Health Department records (n = 361) for mortality and survival outcomes. Participation in CR, age, gender prior history of cardiac event, and diagnosis were used to predict readmission, mortality, and survival. Results: Approximately half (52.1%) the sample participated in CR. Participants included 72% males, average age 68 years (38-91 years), and were predominantly Non-Hispanic white. CR participants attended an average of 20 sessions. CR group differed in diagnoses MI (58.5%), CABG (57.4%) and in prior history of heart disease (25.4%) from the non-cardiac rehabilitation (NCR) group (83.2%, 25.4%, 42.2%, respectively) ( P < .05). After controlling for the covariates in logistic regression analyses, the CR group independently predicted lower all-cause mortality (odds ratio, OR = 0.22, 95% CI 0.12 to 0.39) and decreased hospital readmissions (OR = 0.48, 95% CI 0.24 to 0.96). After controlling for the covariates in survival analysis, the CR group significantly contributed to decreased likelihood of death hazard (hazard ratio = 0.36, 95% CI 0.24 to 0.54). Median survivor time for the participants was 5.91 years, SD = 3.81 years. Conclusions: Participation in CR for middle age and elderly patients is associated with increased survival, a marked decrease in all-cause mortality, and a decrease in cardiovascular-related hospital readmission. A referral to a nationally certified outpatient CR program prior to hospital discharge and early enrollment may improve LT outcomes.

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An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation

Circulation ◽

10.1161/circulationaha.112.121996 ◽

2013 ◽

Vol 127 (3) ◽

pp. 349-355 ◽

Cited By ~ 65

Author(s):

Quinn R. Pack ◽

Mouhamad Mansour ◽

Joaquim S. Barboza ◽

Brooks A. Hibner ◽

Meredith G. Mahan ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Hospital Discharge

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Design of an early remote coaching program to bridge the gap from hospital discharge to the start of cardiac rehabilitation. (Preprint)

10.2196/preprints.34974 ◽

2021 ◽

Author(s):

Paul Keessen ◽

Ingrid CD van Duijvenbode ◽

Corine HM Latour ◽

Roderik A Kraaijenhagen ◽

Veronica R Janssen ◽

...

Keyword(s):

Side Effects ◽

Cardiac Rehabilitation ◽

Hospital Discharge ◽

Treatment Plan ◽

Health Behavior Change ◽

Support Needs ◽

Structured Interviews ◽

Literature Study ◽

Daily Physical Activities ◽

Tailored Information

BACKGROUND Remote coaching might potentially be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR). OBJECTIVE To explore and summarize information- and support needs of patients with CAD, and to develop an early remote coaching program providing tailored information and support. METHODS We used the intervention mapping (IM) approach to develop a remote coaching program. Three consecutive steps were completed in this study: (1) identification of information- and support needs in patients with CAD, using an exploratory literature study and semi-structured interviews; (2) definition of program objectives; (3) selection of theory-based methods and practical intervention strategies. RESULTS Our exploratory literature study (n=42) and semi-structured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about: CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: 1. Patients gain knowledge on how CAD and revascularization affects their bodies and health. 2. Patients gain knowledge about medication and side effects and adhere to their treatment plan. 3. Patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active. 4. Patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as theoretical framework, and behavioral counseling and video modelling as practical strategies for the program. CONCLUSIONS In this study we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.

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Abstract 70: Participation in Cardiac Rehabilitation Is Associated with Reduced Rehospitalization Following Acute Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a70 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Shannon M Dunlay ◽

Victoria N Zysek ◽

Quinn R Pack ◽

Randal J Thomas ◽

Jill M Killian ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Rehabilitation ◽

Hospital Discharge ◽

Univariate Analysis ◽

Billing Data ◽

Post Discharge ◽

Repeated Events ◽

Reduced Risk

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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