Gaps in Referral to Cardiac Rehab after PCI

JACC in a Flash | Many patients do not receive referrals for guideline-recommended cardiac rehabilitation after angioplasty, according to a new study published May 11 in JACC. The researchers found high variation between regions of the U.S., with the Midwest being the most likely to refer patients for cardiac rehab at 76 percent, compared with 55 percent in the South, 50 percent in the Northeast and 49 percent in the West.

Participation in cardiac rehabilitation is associated with better clinical outcomes including lower mortality and rehospitalization rates. Patients are much more likely to participate in these programs if they have been referred by their physician.

The study, based on data from the ACC’s NCDR CathPCI Registry® between July 2009 and March 2012, found that other institutional characteristics such as volume of angioplasty procedures, larger hospital size, as well as private and community hospitals could also influence the rate of referrals. Physicians may also be more likely to refer patients they feel are more likely to participate in, complete and benefit from a cardiac rehabilitation program rather that referring all patients.

On average, about 60% of all percutaneous coronary intervention patients were referred for cardiac rehabilitation. The rates were much lower than the rates of patients who were prescribed preventative medications. 97.5 percent of patients were prescribed aspirin and 89.8% were prescribed statins.

The findings here differed from previous studies in that it did not find a lack of insurance as a strong factor in non-referrals. Other factor such a patient age or comorbidities such as hypertension or diabetes also did not have much influence on referral rates. Patients who had had a heart attack were slightly more likely to be referred for cardiac rehab at a rate of 66 percent.

The authors conclude that these findings suggest a need to “identify and assist underperforming institutions through hospital-level interventions and ongoing efforts to monitor for future improvements in national cardiac rehabilitation referral rates.”

Aragam KG, Dai D, Neely ML, et al. J Am Coll Cardiol. 2015;65(19):2079-88.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: CardioSource WorldNews, Angioplasty, National Cardiovascular Data Registries, CathPCI Registry, Rehabilitation, Percutaneous Coronary Intervention

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