Cardiac Rehabilitation Utilization During an Acute Cardiac Hospitalization

Abstract

Background: Inpatient cardiac rehabilitation (ICR) programs provide important services to hospitalized patients by delivering risk factor education, daily ambulation, and facilitation of referral to outpatient cardiac rehabilitation. However, little is known about ICR utilization or practice patterns. Methods: We examined the use of ICR, between January 2007 and June 2011, in a geographically and structurally diverse sample of US hospitals (Premier, Inc.). Results: Among 458 hospitals, there were 1 343 537 admissions with a qualifying diagnosis for outpatient cardiac rehabilitation. Formal ICR was available at 223 (49%) of these hospitals. Overall, patient utilization of ICR was low (21.2%) and varied by indication. Utilization was highest in those undergoing cardiac surgery (43.3%) and lowest in patients with medically managed myocardial infarction (15.6%) or heart failure (10.6%). A larger bed count, the presence of cardiac interventional services, and Midwest location were associated with increased likelihood of a hospital having an ICR program. In multivariable hierarchical analysis adjusting for known hospital characteristics among hospitals that provided ICR, multiple patient factors were associated with a lower likelihood of ICR utilization, including older age, more comorbidities, female sex, and Medicare insurance, but unspecified hospital characteristics explained the vast majority of the variability. Conclusions: We found substantial variation in the delivery of ICR across US hospitals and by patient condition. Overall, only a minority of eligible patients ever received ICR and fewer than half of hospitals treating cardiac patients provided formal ICR services. This substantial gap in the secondary prevention of heart disease warrants further investigation and intervention.

Trends in the Use of Cardiac Rehabilitation in Japan Between 2010 and 2017 ― An Epidemiological Survey ―

“…Similar results have been reported in other studies: participation rates were higher in patients who had undergone cardiac surgery or had AMI and were lower in patients with medically managed HF or stable AP. 11,22 Furthermore, the present study showed that the annual increases in the ICR participation rates were significantly lower in patients with AP and PAD than in patients with AMI, PCS, and HF. Rehabilitation for postoperative patients is likely to be included as part of the postoperative care, which aims for functional recovery and the prevention of complications.…”

Health-related quality of life and associated factors in patients with myocardial infarction after returning to work: a cross-sectional study

“…Moreover, the adherence of CR in this study needs to be improved. Less than 40% of patients completed CR, however, the completion of CR is a critical element to ensure the benefit of CR [38]. Most patients gave up the rehabilitation procedure because the benefits of CR did not seem obvious in the short-term.…”

Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis

“…In-hospital exercises include breathing techniques, transfer between bed and chair, and walking along the ward. In the U.S.A., almost 20% of patients after cardiac surgery received no physical therapy or inpatient cardiac rehabilitation, and when this is utilized, often less than 30% of the hospital days are covered [ 8 ], without weekend day services [ 9 ]. Although interventions are hard to compare, the early mobilization of patients might improve physiological functional capacity, might accelerate recovery, and might reduce hospital length of stay [ 10 , 11 ].…”