Cardiac Rehabilitation Wait Times

Russell, Kelly L.; Holloway, Tanya M.; Brum, Margaret; Caruso, Veola; Chessex, Caroline; Grace, Sherry L.

doi:10.1097/hcr.0b013e318228a32f

Cited by 70 publications

(54 citation statements)

References 12 publications

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“…Elle montre néanmoins que, parmi les patients auxquels un tel programme est proposé, le pourcentage de ceux qui sont effectivement pris en charge n'est pas celui que l'on pourrait souhaiter. Le temps écoulé entre le moment où le patient est adressé au centre de RC et celui où il est admis peut avoir un impact négatif sur le taux d'inclusion, 10 ce facteur expliquant peut-être le faible pourcentage d'inscriptions observé dans la présente cohorte, les délais médians et moyens entre l'orientation des patients vers le centre de RC et leur admission dans le programme ayant été, respectivement, de 84 jours et de plus de 100 jours. Les femmes (20,8 % de la cohorte) et les patients âgés de plus de 75 ans (10,3 % de la cohorte) étaient globalement sous-représentés et l'étaient encore plus dans le sous-groupe des patients ayant accompli la totalité du programme de RC.…”

Section: Disclosuresunclassified

“…It does show, however, that enrollment rates are lower than desirable among those referred. Long delays between referral and enrollment can adversely affect enrollment rates 10 and may have contributed to low enrollment rates in the current cohort with median and mean times from referral to enrollment of 84 days and Ͼ100 days, respectively. Women (20.8% of the cohort) and patients Ͼ75 years of age (10.3% of the cohort) were underrepresented overall and even more so among the subgroup of CR completers.…”

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confidence: 99%

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Cardiac Rehabilitation

Bittner

2012

Circulation

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ardiac rehabilitation (CR) is a multidisciplinary, secondary prevention treatment modality 1 that reduces mortality and morbidity among patients with coronary heart disease and improves symptoms, functional capacity, metabolic status, depression, and health-related quality of life. 2,3 A recent analysis suggested that CR contributed significantly to the reduction in coronary heart disease mortality observed in the United States between 1980 and 2000 and that the risk reduction attributable to CR was comparable to reductions attributed to postevent aspirin, ␤-blocker, angiotensinconverting enzyme inhibitor, statin, and warfarin therapy as well as to risk reductions attributed to acute thrombolysis and revascularization. 4 CR is considered a Class I indication after acute coronary syndrome, coronary revascularization, and for stable angina, but remains underutilized with low referral, low enrollment, and low completion rates and considerable disparities in access. 5,6 Article see p 677Many of the benefits of CR were demonstrated in clinical trials that predate contemporary treatments for coronary heart disease, in patient populations cared for in tertiary care settings, or in large administrative data sets which lack granularity regarding patients' clinical characteristics, disease severity, and concomitant therapy. 3,7,8 In this issue of Circulation, Martin et al 9 assessed mortality rates, hospitalizations, cardiac hospitalizations, and emergency department visits among 5886 individuals who had undergone cardiac catheterization, had detailed data collected at the time of the index event, and were referred to a single, centralized, communitybased CR program within 1 year of the index event. Median follow-up was 5.37 years. More than 40% of eligible patients who were referred chose not to attend, and an additional 9% enrolled but did not complete the program. Compared to CR completers, those who did not enroll or did not complete were older and sicker, more likely to be women, and more likely to be economically disadvantaged. CR completers had the lowest mortality rate, lowest hospitalization rates, and fewest emergency room visits. The relationship between CR completion and lower mortality rate was robust across unadjusted, adjusted, and propensity-matched analyses with hazard ratios between 0.57 and 0.67 for completers versus noncompleters. A similarly robust effect was seen for hospitalization rates, while there was no significant benefit of CR completion in relation to emergency room visits after adjustment for important covariates. Of note, individuals who enrolled in CR, but did not complete, had the highest rates of hospitalization and emergency room use and had mortality rates similar to those who chose not to attend. This study's major strength is the availability of detailed demographic and clinical information before CR enrollment and complete ascertainment of mortality and important health care utilization measures after enrollment achieved by linking several large databases. Through propensity-matchi...

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confidence: 99%

Cardiac Rehabilitation

Bittner

2012

Circulation

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“…Preliminary retrospective studies suggest that for every day of delay between hospital discharge and CR attendance, there is an associated 1% decrease in participation. 14 The reasons for this delay are unclear but may relate to the need to obtain insurance preauthorization, difficulty in arranging patient appointments after hospital discharge, program capacity restraints, or residual concerns about the safety of early exercise after MI. Recently, however, the safety of early exercise after MI or PCI has been demonstrated [15][16][17] and should no longer be a significant consideration for patients who are stable.…”

Section: Clinical Perspective On P 355mentioning

confidence: 99%

“…11,12 However, the time from hospital discharge to CR enrollment currently averages ≈35 days 13,14 and represents a modifiable factor that could potentially affect participation. Preliminary retrospective studies suggest that for every day of delay between hospital discharge and CR attendance, there is an associated 1% decrease in participation.…”

Section: Clinical Perspective On P 355mentioning

confidence: 99%

“…13,14 Each of the 5 CR sites offered a specified weekly orientation session, and information about a patient's specific appointment day and time was delivered to them by a study representative. Residents and fellows were instructed to minimize patient contact after randomization: They briefly noted the date, time, and location for the first appointment in CR; collected completed surveys; provided a program brochure; and answered simple residual questions about CR in general.…”

Section: Randomization and Blindingmentioning

confidence: 99%

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An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation

et al. 2013

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Background-Outpatient cardiac rehabilitation (CR) decreases mortality rates but is underutilized. Current median time from hospital discharge to enrollment is 35 days. We hypothesized that an appointment within 10 days would improve attendance at CR orientation. Methods and Results-At hospital discharge, 148 patients with a nonsurgical qualifying diagnosis for CR were randomized to receive a CR orientation appointment either within 10 days (early) or at 35 days (standard). The primary end point was attendance at CR orientation. Secondary outcome measures were attendance at ≥1 exercise session, the total number of exercise sessions attended, completion of CR, and change in exercise training workload while in CR. Average age was 60±12 years; 56% of participants were male and 49% were black, with balanced baseline characteristics between groups. Median time (95% confidence interval) to orientation was 8.5 (7-13) versus 42 (35 to NA [not applicable]) days for the early and standard appointment groups, respectively (P<0.001). Attendance rates at the orientation session were 77% (57/74) versus 59% (44/74) in the early and standard appointment groups, respectively, which demonstrates a significant 18% absolute and 56% relative improvement (relative risk, 1.56; 95% confidence interval, 1.03-2.37; P=0.022). The number needed to treat was 5.7. There was no difference (P>0.05) in any of the secondary outcome measures, but statistical power for these end points was low. Safety analysis demonstrated no difference between groups in CR-related adverse events. Conclusions-Early

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Triage in Nonemergency Services

Harding

Taylor

2013

International Series in Operations Research &Amp; Management Science

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Cardiac Rehabilitation Wait Times

Cited by 70 publications

References 12 publications

Cardiac Rehabilitation

Cardiac Rehabilitation

An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation

Triage in Nonemergency Services

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