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• W2518259029 abstract "Background: Although currently an endorsed performance measure of quality, cardiac rehabilitation (CR) referral rates remain quite low. Established guidelines describe recommended core components of CR programs for risk factor management: nutritional counseling; physical activity counseling; exercise training; smoking cessation; and weight, hypertension, lipid, diabetes, and psychosocial management. We sought to determine the variability in hospital referral rates for CR and assess whether patients are more likely to be referred who have risk factors that are intervention targets of the core components of CR. Methods: We assessed referral to outpatient CR among 3632 MI patients from 22 US hospitals in the TRIUMPH study who were discharged home with risk factor data available. Variation in CR referral rates across hospitals was quantified by the median rate ratio (MRR). The prediction of CR referral by 8 individual risk factors that are intervention targets of CR was assessed using hierarchical modified Poisson regression, adjusting for study site and 16 demographic and clinical patient characteristics. Results: Upon hospital discharge, only 39.1% (n=1420) of patients were referred to CR. Referral rates varied greatly across sites, ranging from 2.6% to 88.2%. After adjusting for potentially confounding patient factors, the MRR was 2.47 (95% CI 1.67, 3.23), indicating an average 2.5 times greater likelihood of 2 hypothetically identical patients being referred to CR upon discharge from 1 random hospital as compared with another. Only 1 of 8 risk factors modifiable by CR core components was associated with increased referral (see figure), with overweight patients (BMI > 25 or waist circumference > 40 in. for men, > 35 in. for women) being more likely to be referred than non-overweight patients (RR 1.09; 95% CI 1.03, 1.15; p<0.01). Conclusion: Among patients discharged home after MI hospitalization, there are marked differences in outpatient CR referral rates by study site, but relatively little association with patient risk factors that the core components of CR programs are specifically designed to modify. This suggests that site-specific factors strongly influence CR referral and site-level interventions to improve referral are likely to most effectively improve compliance with this performance measure." @default.
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• W2518259029 date "2013-05-01" @default.
• W2518259029 modified "2023-10-16" @default.
• W2518259029 title "Abstract 335: Cardiac Rehabilitation Referral After Acute Myocardial Infarction: Variation in Referral Rates and Association with Core Components of Risk Factor Management" @default.
• W2518259029 doi "https://doi.org/10.1161/circoutcomes.6.suppl_1.a335" @default.
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