Chronic Disease

Many patients with coronary artery disease who could benefit from cardiac rehabilitation are not referred for this treatment

Despite the proven benefits of cardiac rehabilitation and guideline recommendations, just over half of patients treated for coronary artery disease (CAD) are referred for cardiac rehabilitation after hospital discharge, according to a new study. Researchers analyzed data on 72,817 patients treated for a heart attack who underwent arterial catheterization to unblock coronary blood flow (percutaneous coronary intervention, or PCI) or who had coronary artery bypass graft surgery (CABG). The patients were discharged from 156 hospitals participating in the American Heart Association's Get with the Guidelines Program. Only 40,974 patients (56 percent) were referred for cardiac rehabilitation upon discharge. The median referral rate by hospital was 43 percent, with some hospitals making no referrals and others referring all eligible patients.

Overall, patients who were referred for rehabilitation tended to be younger, male, or white. Also, those who underwent PCI were nearly twice as likely and those who underwent CABG procedures were three times as likely to be referred for cardiac rehabilitation. Those who were over 80 years old, seen for unstable angina, were on chronic dialysis, or had an implantable pacemaker were 24 percent, 37 percent, 21 percent, and 26 percent less likely, respectively, to be referred for cardiac rehabilitation.

Limitations of the study include voluntary participation by the hospitals and large amounts of missing data about referral to cardiac rehabilitation in the patient records. If anything, the researchers write, the referral rate is likely to represent a best-case scenario among U.S. hospitals. They assert that 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. The study was funded in part by the Agency for Healthcare Research and Quality (HS13852).

More details are in "Predictors of cardiac rehabilitation referral in coronary artery disease patients. Findings from the American Heart Association's Get With the Guidelines Program," by Todd M. Brown, M.D., M.S.P.H., Adrian F. Hernandez, M.D., M.H.S., Vera Bittner, M.D., M.S.P.H., and others in the June 2009 Journal of the American College of Cardiology 54(6), pp. 515-521.

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