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.

Download full-text


Available from: Gregg C. Fonarow, May 08, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Coronary heart disease is the leading killer of women worldwide. Empirical literature documents substantial morbidity and mortality benefits for cardiac rehabilitation participants. Scientific advances have informed the development of evidence-based guidelines for improving the delivery of cardiac rehabilitation yet persistent themes surrounding the substandard referral and utilization rates by women continue unabated in the literature. This review provides an update of the current status of cardiac rehabilitation for women, including a brief overview of the latest findings regarding the unique presentations of heart disease in women. An innovative secondary prevention program, designed exclusively for women is described, and illustrates an attempt to modify a contemporary traditional cardiac rehabilitation program to improve attendance rates and health outcomes in women. Future research with large, diverse samples of women are essential for guiding gender-appropriate referral strategies, effective modifications to traditional center-based programs, and the efficacy of alternative cardiac rehabilitation care models for women.
    Current Cardiovascular Risk Reports 10/2012; 6(5). DOI:10.1007/s12170-012-0255-z
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introducción y objetivos. En ensayos clínicos y metaanálisis se ha demostrado que la trombólisis extrahospitalaria es eficaz. Nuestro objetivo es analizar el manejo del infarto agudo de miocardio por equipos de emergencias extrahospitalarios, así como evaluar los factores asociados a la aplicación de fibrinólisis extrahospitalaria. Pacientes y método. Registro prehospitalario continuo de pacientes atendidos y diagnosticados de síndrome coronario agudo con elevación del segmento ST por los equipos de emergencias extrahospitalarios de Andalucía. Duración: 2 años (2001-2002). Se realiza un seguimiento al ingreso hospitalario y al mes de éste. Resultados. Se atendió a un total de 981 pacientes, con una edad media de 65 ± 13 años, de los que 777 (79,2%) eran varones. Se realizaron 152 (15,5%) fibrinólisis extrahospitalarias. El 18% de éstas se realizó en la primera hora de evolución y el 68% en las primeras 2 h, sin que se produjeran accidentes cerebrovasculares hemorrágicos posfibrinólisis. La mortalidad en el ingreso hospitalario fue de 206 pacientes (21%), de los cuales 8 (0,8%) fueron tratados con fibrinólisis extrahospitalaria. Las variables asociadas a la administración de fibrinólisis extrahospitalaria fueron la edad < 55 años (p < 0,0001), la presión arterial sistólica normal (odds ratio = 6,825; intervalo de confianza del 95%, 2,442-19,069) y el diagnóstico hospitalario de infarto agudo de miocardio anterior (p < 0,022). Conclusiones. La fibrinólisis extrahospitalaria realizada por los equipos de emergencias permite aplicar el tratamiento dentro de los intervalos óptimos de tiempo. La mortalidad en el ingreso hospitalario en este subgrupo de pacientes es menor que en los no tratados con fibrinólisis extrahospitalaria. Además, la baja tasa de complicaciones muestra la seguridad del procedimiento. No obstante, los pacientes tratados con fibrinólisis extrahospitalaria parecen ser los de menor riesgo.
    Revista Espa de Cardiologia 11/2005; DOI:10.1157/13080957 · 3.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Participation rates in cardiac rehabilitation after myocardial infarction (MI) remain low. Studies investigating the predictive value of psychosocial variables are sparse and often qualitative. We aimed to examine the demographic, clinical, and psychosocial predictors of participation in cardiac rehabilitation after MI in the community. Olmsted County, Minnesota, residents hospitalized with MI between June 2004 and May 2006 were prospectively recruited, and a 46-item questionnaire was administered before hospital dismissal. Associations between variables and cardiac rehabilitation participation were examined using logistic regression. Among 179 survey respondents (mean age 64.8 years, 65.9% male), 115 (64.2%) attended cardiac rehabilitation. The median (25th-75th percentile) number of sessions attended within 90 days of MI was 13 (5-20). Clinical characteristics associated with rehabilitation participation included younger age (odds ratio [OR] 0.95 per 1-year increase), male sex (OR 1.93), lack of diabetes (OR 2.50), ST-elevation MI (OR 2.63), receipt of reperfusion therapy (OR 7.96), in-hospital cardiologist provider (OR 18.82), no prior MI (OR 4.17), no prior cardiac rehabilitation attendance (OR 3.85), and referral to rehabilitation in the hospital (OR 12.16). Psychosocial predictors of participation included placing a high importance on rehabilitation (OR 2.35), feeling that rehabilitation was necessary (OR 10.11), better perceived health before MI (excellent vs poor OR 7.33), the ability to drive (OR 6.25), and post-secondary education (OR 3.32). Several clinical and psychosocial factors are associated with decreased participation in cardiac rehabilitation programs after MI in the community. As many are modifiable, addressing them may improve participation and outcomes.
    American heart journal 11/2009; 158(5):852-9. DOI:10.1016/j.ahj.2009.08.010 · 4.56 Impact Factor
Show more