Today's post is from Randal J. Thomas, MD, MS, FAACVPR, FACC, FAHA, chair of the writing committee for the performance measures for cardiac rehabilitation discussed below, and a cardiologist at Mayo Clinic.

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The ACC, American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation on Monday released updated performance measures for cardiac rehabilitation. Cardiac rehab is associated with a 20-30% reduction in all-cause mortality rates and helps promote other significant health benefits in patients after myocardial infarction, CABG surgery, percutaneous coronary intervention, heart valve surgery, and heart transplantation surgery or in those with chronic stable angina.

Despite the significant benefits of cardiac rehabilitation, only one in five eligible patients receives it. 

Why are there so few physician referrals? There appear to be at least four reasons:

1. Lack of awareness of the benefits of cardiac rehabilitation.
2. Lack of awareness of that health insurance policies cover cardiac rehabilitation services.
3. Lack of awareness of the location of cardiac rehabilitation programs in their area for specific patients.

With all the competing demands on a provider’s time—sometimes due to the numerous clinical demands--a provider might simply forget to include referral to cardiac rehabilitation for their patients who are eligible.

On the patient side, there are also significant barriers that keep patients from participating in cardiac rehabilitation.  Some patients aren’t aware of the benefits and the insurance coverage policies for cardiac rehabilitation.  Some have financial, time, or logistical restraints that interfere with their participation in cardiac rehabilitation.

On the health care system side, lack of access to a nearby cardiac rehabilitation program and lack of health care insurance are significant barriers to participation.

While these barriers are significant, there are movements in play that are likely to help reduce these barriers and improve the delivery of cardiac rehabilitation.

One such activity is the use of cardiac rehabilitation performance measures.  The performance measures include two parts, the first offering a set of measures for the referral of patients to cardiac rehab programs from the inpatient and outpatient settings. Health care providers and health care systems will report the percentage of eligible patients they refer to cardiac rehab programs.  The second set is for the delivery of cardiac rehab services.  Cardiac rehab programs will report on these measures.

The hope behind the performance measures is to increase patient referrals by helping health care providers more easily track referral rates, adopt tools to improve enrollment, and assess and improve the quality of care provided. In particular, the performance measures stress tracking referral rates and then implementing solutions to improve these rates. System-based approaches, such as automatic ordering sets for referring eligible patients to a cardiac rehab program, have been shown to improve referral and enrollment rates.

Patient Education

To help patients understand cardiac rehab better, ACC’s patient education initiative, CardioSmart, recently released a new video, “Cardiac Rehabilitation: Your Journey Back to Heart Health.” The video follows three recovering heart patients and chronicles how cardiac rehab has help change their lives. The video is available online (www.cardiosmart.org/cardiacrehab.aspx) or you can request a DVD copy from Melissa Ketchum at mketchum[at]acc.org.

Photo courtesy of the AACPR website.

See all the guest posts on the ACC in Touch Blog.

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