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Cardiac rehab referral rates lacking after CICU discharge, especially for patients with HF
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In a new study, nearly 63% of patients discharged from the cardiac ICU had an indication for cardiac rehabilitation, yet only 30% were referred upon discharge.
According to results published in the American Journal of Cardiology, cardiac rehabilitation was most commonly indicated in patients with HF with reduced ejection fraction (38%), those who underwent cardiothoracic surgery (26%) and those with STEMI (23%). While only 30% of indicated patients received a cardiac rehabilitation upon referral from the cardiac ICU, the percentage of referred patients grew to 63% at 18 months post-discharge.
Researchers found that patients were most frequently referred for cardiac rehabilitation at discharge from the cardiac ICU following STEMI (91%), -non-NSTEMI (80%) and post-percutaneous coronary intervention (80%).
When the researchers analyzed referral rates among patients with HFrEF, they found that only 35% of discharges were referred.
“Despite known benefits from [cardiac rehabilitation] such as improved quality of life and decreased hospitalization rates, heart failure patients can have referral rates as low as 10%. In our study, we also found that heart failure patients represented the subgroup with the lowest rate of referral,” Michael Sola, MD, of the department of internal medicine at University of Michigan, and colleagues wrote. “Interestingly, these referral rates were higher than national averages over the course of our study. However, when compared to referral rates with patients following STEMI and cardiothoracic surgery, it is clear heart failure patients represent a population with significant underutilization of CR.”
This retrospective study included patients aged 18 years or older who were admitted to the University of Michigan cardiac ICU for more than 48 hours from March 2016 to March 2017. The study excluded patients with in-hospital mortality or those discharged against medical advice, to hospice or to transfer. If cardiac rehabilitation was indicated, based on ACC/AHA guidelines, researchers reviewed medical records through September 2017 to determine referral and participation rates. If there was no referral, records were analyzed for potential barriers to CR referral.
In other results, the researchers found nonreferral was “rarely documented.” In this study, among those not referred for cardiac rehabilitation, 87% of cases did not have an explanation documented for non-referral.
“[Developing] systems to promote [cardiac rehabilitation] referral in HFrEF following CICU admission has the potential to improve utilization of an intervention with proven clinical benefit,” the authors wrote.
Researchers suggested potential solutions such as requiring inpatient physicians to determine patient candidacy for cardiac rehabilitation as part of the hospital discharge process and automated cardiac rehabilitation referral or home-based cardiac rehabilitation programs to improve patient enrollment. However, they stated the feasibility and efficacy of these potential solutions require further evaluation. – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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