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Cardiac rehabilitation referral less frequent after PCI than surgery
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Fewer patients were referred to cardiac rehabilitation after PCI than after cardiac surgery, with referral rates varying significantly by hospital, according to a study.
Using data from the Clinical Outcomes Assessment Program registry, Alexis L. Beatty, MD, MAS, from the VA Puget Sound Health System and the University of Washington in Seattle, and colleagues examined variation in cardiac rehabilitation referral after PCI, CABG and valve surgery. The registry included data from all nonfederal hospitals performing PCI and cardiac surgery in Washington.
The analysis included 71,556 patients undergoing PCI and 23,972 undergoing cardiac surgery from 2010 to 2015. Compared with 91% of patients who underwent cardiac surgery, only 48% of those who underwent PCI were referred to cardiac rehabilitation at discharge, according to the data.
The prevalence of cardiac rehabilitation referral varied widely by hospital, ranging from 3% to 97% after PCI and from 54% to 100% after cardiac surgery, the researchers reported. In multivariable analyses, the hospital performing the procedure proved to be a stronger predictor of referral than any individual patient characteristic for PCI (median OR = 5.94; 95% CI, 4.1-9.49) and cardiac surgery (median OR = 7.09; 95% CI, 3.79-17.8).
Referral to cardiac rehabilitation after PCI was more likely among hospitals with an outpatient cardiac rehabilitation program (OR = 7.19; 95% CI, 2.03-25.39). The same was true for referral after cardiac surgery, but the finding was not statistically significant (OR = 1.89; 95% CI, 0.13-28.43), the researchers found.
Data also indicated that having a cardiac rehabilitation program explained only 10% of the hospital-level variation in referral after PCI and 0% of variation after cardiac surgery.
The researchers noted, however, that from 2010 to 2015, cardiac rehabilitation referral did increase from 42% to 49% among patients who had PCI (P for trend < .001) and from 91% to 95% for patients who had cardiac surgery (P for trend < .001).
“Cardiac rehabilitation referral at discharge was less prevalent after PCI than cardiac surgery. The strongest predictor of cardiac rehabilitation referral was hospital in which the procedure was performed, and department-level variation may exist within hospitals,” the researchers wrote. “Efforts to improve cardiac rehabilitation referral should focus on hospital and departmental policies increasing referral after PCI, especially in low referral hospitals.” – by Melissa Foster
Disclosures: The authors report no relevant financial disclosures.
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