Increasing Referral and Participation Rates to Outpatient Cardiac Rehabilitation: The Valuable Role of Healthcare Professionals in the Inpatient and Home Health Settings: A Science Advisory From the American Heart Association

Abstract

Physical Activity and Metabolism C ardiovascular disease (CVD) continues to be the leading cause of morbidity and mortality in the United States and worldwide.1 In fact, the prevalence of CVD is on the rise as a function of increased longevity and the mounting effects of cardiac risk factors that typically accumulate over a lifetime.Outpatient cardiac rehabilitation (CR) programs offer a costeffective, multidisciplinary, comprehensive approach to address these risk factors and to restore individuals to their optimal physiological, psychosocial, nutritional, and functional status.[2][3][4][5][6] Thus, the benefits of CR extend well beyond the cardiovascular system, positively affecting an individual's overall health status.These benefits may be particularly important to certain CVD cohorts such as elderly patients who are more likely to present with greater functional limitations and frailty.Additionally, outpatient CR has been shown to dramatically reduce morbidity and mortality by nearly 25% compared with usual care.7,8 Despite the clear benefits of formal, supervised outpatient CR and exercise training programs, as well as strides in automatic referrals, 9 current statistics continue to demonstrate that referral and participation rates of eligible patients remain alarmingly low, 10 -13 with participation particularly poor in rural areas and in eligible patients who have lower socioeconomic status, limited education, advanced age, and/or female sex.14,15 In addition, Gurewich et al 16 reported several factors that are likely responsible for the poor referral rates to outpatient CR, which included "the degree of automation and assertiveness in securing referrals, the level of integration of CR within the hospital setting and physician community, the relationship to other CR facilities, and capacity constraints."Given the continually poor referral and participation rate in outpatient CR despite increased efforts to reverse this trend, additional actions are required.This scientific advisory calls on the inpatient and home healthcare teams (physicians, physician assistants, nurse practitioners, nurses, physical therapists [PTs], clinical exercise physiologists [CEPs], registered dieticians, and CR team members) to implement a coordinated effort to promote outpatient CR to eligible patients and to facilitate referral and enrollment.Furthermore, The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science