An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation: A Randomized, Single-Blind, Controlled Trial

Study Questions:

Would an appointment for cardiac rehabilitation (CR) within 10 days of discharge improve attendance at CR orientation over the standard 35 days?

Methods:

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 endpoint 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.

Results:

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 [CI]) to orientation was 8.5 (7-13) versus 42 (35 to 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% CI, 1.03-2.37; p = 0.022). The number needed to treat was 5.7. There was no difference in any of the secondary outcome measures, but statistical power for these endpoints was low. Safety analysis demonstrated no difference between groups in CR-related adverse events.

Conclusions:

The authors concluded that early appointments for CR significantly improve attendance at orientation. This simple technique could potentially increase initial CR participation nationwide.

Perspective:

The impact of CR on outcome in coronary disease is comparable to statins, angiotensin-converting enzyme inhibitors, and beta-blockers. Among the major reasons for inadequate attendance includes physician failure to refer, distance to travel, return to work, and too busy. This study supports clinical experience showing that early appointments prior to return to work improve participation. The percent of attendance is far above norm, suggesting that the CR educational program predischarge provided by house staff influenced the results in both groups.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins, Exercise

Keywords: Outcome Assessment (Health Care), Risk, Return to Work, Cardiology, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Exercise, Coronary Disease


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