Predictors of Cardiac Rehabilitation Referral in Coronary Artery Disease Patients Findings From the American Heart Association's Get With The Guidelines Program

University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Journal of the American College of Cardiology (Impact Factor: 15.34). 09/2009; 54(6):515-21. DOI: 10.1016/j.jacc.2009.02.080
Source: PubMed

ABSTRACT Our purpose was to determine factors independently associated with cardiac rehabilitation referral, which are currently not well described at a national level.
Substantial numbers of eligible patients are not referred to cardiac rehabilitation at hospital discharge despite proven reductions in mortality and national guideline recommendations.
We used data from the American Heart Association's Get With The Guidelines program, analyzing 72,817 patients discharged alive after a myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery between January 2000 and September 2007 from 156 hospitals. We identified factors associated with cardiac rehabilitation referral at discharge and performed multivariable logistic regression, adjusted for clustering, to identify which factors were independently associated with cardiac rehabilitation referral.
Mean age was 64.1 +/- 13.0 years, 68% were men, 79% were white, and 30% had diabetes, 66% hypertension, and 52% dyslipidemia; mean body mass index was 29.1 +/- 6.3 kg/m(2), and mean ejection fraction 49.0 +/- 13.6%. All patients were admitted for coronary artery disease (CAD), with 71% admitted for myocardial infarction. Overall, only 40,974 (56%) were referred to cardiac rehabilitation at discharge, ranging from 53% for myocardial infarction to 58% for percutaneous coronary intervention and to 74% for coronary artery bypass graft patients. Older age, non-ST-segment elevation myocardial infarction, and the presence of most comorbidities were associated with decreased odds of cardiac rehabilitation referral.
Despite strong evidence for benefit, only 56% of eligible CAD patients discharged from these hospitals were referred to cardiac rehabilitation. Increased physician awareness about the benefits of cardiac rehabilitation and initiatives to overcome barriers to referral are critical to improve the quality of care of patients with CAD.

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    ABSTRACT: Background Cardiac rehabilitation (CR) improves coronary artery disease risk factors and mortality. Outcomes following CR in African-Americans (AAs) compared to Caucasians have not been studied extensively. Methods 1,096 patients (169 AA, 927 Caucasian) were enrolled in a 36-session CR program for ischemic heart disease or post-cardiac surgery. The program consisted of exercise, lifestyle modification, and pharmacotherapy. Results Following CR, quality of life, blood pressure, and low-density lipoprotein cholesterol improved significantly in both AAs and Caucasians, although to a lesser degree in AAs. Caucasians also had significant improvements in weight and triglyceride concentrations. Overall, mean peak exercise capacity, measured in metabolic equivalents (METs), improved by only 1.6 (95% confidence interval [CI] 1.3 to 1.8) in AAs compared to 2.4 (2.3 to 2.6) in CCs, p < 0.001 for AAs vs CCs. AA women had the least improvement in METs, but changes were still significant (1.1 [CI 0.9 to 1.4]). The subgroup with the least improvement in METs were AA diabetic patients (1.4 (CI 1.1 to 1.7]). Conclusion AAs derive a significant benefit from CR, but not to the same degree as Caucasians, based on changes in risk factors and in exercise capacity. Within both ethnic groups, both women and diabetic patients appeared to have markedly less improvement.
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