The Case for Cardiac Rehabilitation
Each year, over 1 million Americans have a coronary event or undergo a cardiac-related procedure that makes them eligible for cardiac rehabilitation (CR). Research shows that this medically supervised program can greatly improve patient outcomes, such as a decreased chance of heart attack recurrence, better medication adherence, and better quality of life. Increasing patient participation from nearly 30% today to Million Hearts' goal of at least 70% by 2027 could save nearly 25,000 lives and prevent about 180,000 hospitalizations annually.
What is cardiac rehabilitation?
CR is a medically supervised, multifaceted, team-based secondary prevention program aimed at improving heart health. It includes supervised exercise training, risk factor management, patient education and heart-healthy skills development, and counseling on stress and other psychosocial factors. CR is typically delivered in the outpatient setting but can be initiated in the inpatient setting. It optimally consists of 36 one-hour sessions. CR is customized to meet each patient's individual needs, optimizing its benefits.
Cardiac rehabilitation lowers the risk of health complications and death for patients who participate and boosts their chances of returning to an active lifestyle. Hospitals can also benefit from optimal provision of CR by potentially increasing patient satisfaction, reducing hospital readmissions, and more.
Who can benefit from CR?
Evidence shows that CR can benefit individuals who have:
- Had a heart attack
- Stable angina
- Received angioplasty or stent
- Heart failure with reduced ejection fraction
- Undergone a bypass, valve, or heart or heart-lung transplant surgery
Despite improved health outcomes for patients and reduced associated hospital readmissions, fewer than 30% of eligible patients participate in cardiac rehabilitation. Participation in CR also is lower among women and people from racial/ethnic minority populations.
Low participation rates result from barriers to referral and barriers to participation. Barriers to referral include gaps in physician awareness of who needs CR and the benefits of it, inconsistency in referral patterns, the absence of an electronic health record system in hospitals that automatically refers eligible patients, and lack of clinician knowledge about available local programs. Barriers to participation include financial and logistical challenges faced by patients (e.g., copays, scheduling, transportation).
CR improves the health of cardiac patients and reduces readmission rates for hospitals, but participation rates remain low due to a variety of challenges. The good news is that proven strategies exist to address these challenges, such as automatic referral and care coordination. Implementing these strategies can increase referrals, improve program enrollment, and encourage patient participation.