Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative

Abstract

The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts’ focus on achieving more than 70% performance in the “ABCS” of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022. Cardiac rehabilitation is a class Ia recommendation of the American Heart Association and the American College of Cardiology after myocardial infarction or coronary revascularization, promotes the ABCS along with lifestyle counseling and exercise, and is associated with decreased total mortality, cardiac mortality, and rehospitalizations. However, current participation rates for CR in the United States generally range from only 20% to 30%. This road map focuses on interventions, such as electronic medical record–based prompts and staffing liaisons that increase referrals of appropriate patients to CR, increase enrollment of appropriate individuals into CR, and increase adherence to longer-term CR. We also calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States.

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

“…One of the goals of the Million Hearts initiative in preventing 1 million CVD events over 5 years is to achieve >70% participation in CR through a roadmap of increased referrals and enrollment and more flexible delivery of CR services. 29 RCT's have been conducted to study home-based CR since 2002, especially among patients at low-risk for recurrent CVD events. In a cohort with ischemic CVD at moderate risk, one RCT found no significant differences between the traditional CR with mixed surveillance, and home-based tele-CR when it came to ET time, energy expenditure, and heart rate (HR) recovery in the first minute after exercise testing; however, HRQoL scores were higher in the conventional group.…”

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

“…Despite the many benefits of CR, referral and participation rates are surprisingly low 7, 8, 9. The Million Hearts Initiatives from the Centers for Disease Control and Prevention set a goal to achieve >70% participation in CR/secondary prevention programs by the year 2022 10. The American Heart Association and the American College of Cardiology recommend CR referral before hospital discharge as a Class I recommendation and listed assessing the impact of better CR referral, initiation, and participation on population outcomes as priority areas 11.…”

Barrier and Resources on Improving the Recovery of Cardiovascular Patient

“…Doing so will save lives, reduce avoidable hospitalizations, and improve the quality of life for hundreds of thousands of individuals in the United States. (6) Rehabilitation program has an effect to intention on improving recovery of cardiovascular patients (p=0.013). The intention has effect to action on improving recovery of cardiovascular patients (p=0.000).…”