Technology-based process boosts cardiac rehab referral rates

March 7, 2018, American College of Cardiology

Simply changing cardiac referral processes to opt-out rather than opt-in significantly increased referral rates, according to a study presented at the American College of Cardiology's NCDR Annual Conference (NCDR.18) in Orlando. The technology-based program also provides resources to staff and patients about the significance and impact of cardiac rehab.

Cardiac rehab is a medically supervised program designed to help improve cardiovascular health in who have experienced a , heart failure, angioplasty or heart surgery. It has been shown to reduce the rates of cardiovascular deaths and readmissions and to improve quality of life in patients with heart disease. It consists of exercise counseling and training; education for heart-healthy living—including smoking cessation tools; and counseling to reduce stress. The study included patients who had a heart attack or stent placement, also called percutaneous coronary intervention (PCI).

"Cardiac rehab gives patients an opportunity to get back to or begin exercising safely under the guidance of a specialist and helps them understand medications they've been placed on," said lead researcher Elizabeth Jolly, RN, BSN, MBA, interventional cardiology transitions coordinator at the Hospital of the University of Pennsylvania in Philadelphia.

Jolly's team—in collaboration with the Penn Medicine Center for Healthcare Innovation—designed intelligent alerts from patients' electronic medical records to alert the Coronary Artery Disease Transitions Coordinator and Case Management Team every morning about which patients potentially could qualify for . Using NCDR criteria, standard phrases were created for use in discharge summaries within the electronic medical record system to meet CathPCI Registry metrics.

More than 40 cardiac rehab facilities in Philadelphia and surrounding counties were identified and then contacted to ensure they would take patients from the and endorse this referral process. If a patient wanted to enroll in a cardiac rehab program, the staff helped them choose a convenient facility in their ZIP code region. The staff member then forwarded the referral to the cardiac rehab facility. The transition coordinator contacted patients within a week of discharge to ask about their plans and facilitated their enrollment into cardiac rehab.

The cardiac team—which included bedside registered nurses, advanced practice providers, physicians and case managers—was educated by Jolly's team on the benefits of cardiac rehab. Educational materials were provided to the discharging nursing units to distribute to all patients after a heart attack or PCI. Staff discussed the benefits of cardiac rehab with eligible patients prior to discharge.

In the 21 months before implementing the program, the hospital's average cardiac rehab referral rate was 12 percent. After the program was implemented, the cardiac referral rate increased to 75 percent in the following three quarters.

In two other hospitals in the University of Pennsylvania health system, the full program was not implemented, but awareness of the importance of cardiac rehab was raised. In those hospitals, the cardiac rehab referral rate rose from 4.2 to 24.8 percent at one hospital and from 4 to 25.4 percent at the second hospital.

Before the new program was implemented, there was no structured referral process for cardiac rehab at the hospital, Jolly said. Health care providers needed to initiate and drive the process of cardiac rehab referral.

"If a provider thought a patient would benefit from cardiac rehab, they would hand the patient a handwritten prescription but didn't have the tools to get them there," Jolly said. "At a big institution like ours, we have so many patients that it's not always evident who qualifies for cardiac rehab. Now we know in real time. We started bringing cardiac into our conversations with patients and adding it to discharge documentation and conversations following discharge as well. Now this is part of our daily workflow."

Explore further: After heart attack, just one in three go for rehab: CDC

Related Stories

After heart attack, just one in three go for rehab: CDC

August 24, 2017
(HealthDay)—Only one in three heart attack survivors in the United States goes for outpatient cardiac rehabilitation, government health officials report.

Too few heart attack patients get cardiac rehab, study finds

August 6, 2015
(HealthDay)—Cardiac rehabilitation programs are considered a key part of recovering from a heart attack—but only a small minority of patients ever attend one, a new study finds.

'Open gym' format shortens waiting time for cardiac rehab

August 30, 2017
Changing from scheduled appointments to an "open gym" format can reduce waiting times for cardiac rehabilitation, reports a study in the September/October issue of Journal of Cardiopulmonary Rehabilitation and Prevention. ...

Reduced anxiety and depression for women participating in women-only cardiac rehab programs

February 3, 2016
Cardiovascular disease is the leading cause of death for women globally. Women who have an acute coronary heart event may be more likely to die or to suffer complications during the initial recovery period than men, but are ...

Institutional factors play role in cardiac rehab referral rates after angioplasty

May 11, 2015
Hospitals in the Midwest were more likely than others to refer patients for guideline-recommended cardiac rehabilitation following angioplasty, possibly because more rehab programs are available in the region, according to ...

Cardiac rehab coverage expands for chronic heart failure patients with symptoms

November 10, 2015
Medicare's and Medicaid's newly extended cardiac rehabilitation coverage for chronic heart failure patients with symptoms has tripled the number who are now eligible, according to a study presented at the American Heart Association's ...

Recommended for you

New cellular pathway helps explain how inflammation leads to artery disease

June 21, 2018
Investigators have identified a new cellular pathway that may help explain how arterial inflammation develops into atherosclerosis—deposits of cholesterol, fats and other substances that create plaque, clog arteries and ...

'Smart stent' detects narrowing of arteries

June 19, 2018
For every three individuals who have had a stent implanted to keep clogged arteries open and prevent a heart attack, at least one will experience restenosis—the renewed narrowing of the artery due to plaque buildup or scarring—which ...

Marriage may protect against heart disease / stroke and associated risk of death

June 18, 2018
Marriage may protect against the development of heart disease/stroke as well as influencing who is more likely to die of it, suggests a pooled analysis of the available data, published online in the journal Heart.

Deaths from cardiac arrest are misclassified, overestimated

June 18, 2018
Forty percent of deaths attributed to cardiac arrest are not sudden or unexpected, and nearly half of the remainder are not arrhythmic—the only situation in which CPR and defibrillators are effective—according to an analysis ...

Tick-borne meat sensitivity linked to heart disease

June 15, 2018
University of Virginia School of Medicine researchers have linked sensitivity to an allergen in red meat—a sensitivity spread by tick bites—with a buildup of fatty plaque in the arteries of the heart. This buildup may ...

The molecules that energize babies' hearts

June 14, 2018
A metabolic process that provides heart muscle with energy fails to mature in newborns with thickened heart walls, according to a Japan–Canada research team.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.