Participation in Cardiac Rehabilitation Programs Among Older Patients After Acute Myocardial Infarction

Abstract

A recent clinical practice guideline strongly supports cardiac rehabilitation for patients after acute myocardial infarction (AMI). 1 Cardiac rehabilitation programs are multifaceted outpatient interventions that include individualized exercise regimens, health education, and structured support focused on cardiovascular risk reduction and medication adherence. 2 Patients typically attend 2 to 3 sessions weekly for up to 36 sessions. Cardiac rehabilitation improves survival after AMI 3 and is associated with improvements in lifestyle, functional capacity, and quality of life for older adults. 4,5 Despite these benefits, rates of referral and participation have traditionally been low, especially among older adults. 6,7 Using a national quality improvement registry, we assessed rates of enrollment in cardiac rehabilitation, as well as completeness of participation (number of sessions attended), among older adults and compared characteristics between patients who did and did not participate after referral.

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

“…IHD patients in this study all met eligibility criteria for cardiac rehabilitation, but only 7.6% reported enrolling in a formal program by the end of the intervention. Nationally, cardiac rehabilitation enrollment rates are suboptimal 8, 10, 11. Although our intervention does not substitute for cardiac rehabilitation, it may be an effective method to increase physical activity in patients who are eligible but do not participate in these programs.…”

“…For example, participation in exercise‐based cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% 4, 5, 6, 7, 8, 9. However, the majority of eligible patients do not participate in a cardiac rehabilitation program 8, 10, 11. Recent evidence also suggests that IHD patients do not often achieve physical activity goals on their own 12…”

Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, and Valve Surgery

“…Finally, this analysis was unable to examine participation in cardiac rehabilitation. Although referral to cardiac rehabilitation is a strong predictor of participation in cardiac rehabilitation, 21,34,35 we cannot determine the predictors of participation in cardiac rehabilitation or the impact on outcomes with this analysis.…”

“…[11][12][13][14] However, referral to and participation in cardiac rehabilitation have historically been poor. 3,[15][16][17][18][19][20][21][22] Previous analyses of acute myocardial infarction and PCI patients have identified both patient and hospital characteristics as predictors of referral to cardiac rehabilitation. [15][16][17]19 Hospital characteristics have been shown to be among the strongest predictors of cardiac rehabilitation referral.…”

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

“…Cardiac rehabilitation (CR), which emphasizes smoking cessation, physical activity, and weight management, can improve physical function, psychosocial well‐being, and quality of life for myocardial infarction (MI) survivors 4, 5, 6. 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.…”