Cardiac rehab participation can be increased by 40 per cent, says study

Health care practitioners can increase the number of patients referred to a cardiac rehabilitation program by more than 40 per cent, helping them to reduce their risk of dying and improve their quality of life, say researchers at the Peter Munk Cardiac Centre.

Researchers explored multiple strategies to increase referrals to cardiac rehabilitation programs at 11 hospitals across Ontario, including using a discharge checklist for doctors, electronic referral in medical records and talking with patients at the bedside.

According to the study, “Effect of Cardiac Rehabilitation Referral Strategies on Utilization Rates”, published in the Feb. 14 edition of the journal Archives of Internal Medicine, a combined approach – a checklist or electronic referral and talking with patients – can increase referrals by 45 per cent. By targeting both health care providers and patients, more than 70 per cent of patients enrol in cardiac rehab.

“Every patient discharged from the hospital with a heart condition should be referred to a cardiac rehab program,” says York kinesiology & health science Professor Sherry Grace (right), principal investigator and director of research for the Cardiovascular Rehabilitation & Prevention Program at the Peter Munk Cardiac Centre, which is part of the University Health Network in Toronto.

“Cardiac rehab is a key component of the continuum of cardiac care. We shouldn’t just discharge patients from the hospital without ensuring there is a link to these proven rehab services to support patients in their recovery,” says Grace.

Cardiac rehabilitation offers a comprehensive approach to health by combining medical treatments and lifestyle modification. Patients are able to benefit from a variety of services, including: education sessions, nutritional assessment with a dietitian, risk factor treatment (hypertension, cholesterol and smoking cessation) by physicians and nurse practitioners, medication review with a pharmacist, targeted exercise prescription by an exercise physiologist, nurse or kinesiologist and supervised exercise.

Previous studies indicate that participating in cardiac rehab after a cardiac illness, such as a heart attack, can reduce the risk of death by approximately 25 per cent, a reduction similar to that of other standard therapies such as cholesterol-lowering medications (statins) and aspirin. In spite of this evidence, only 20 to 30 per cent of patients are referred to a cardiac rehabilitation program after hospital discharge, a phenomenon observed in many countries.

Joe Walters, 55, lost 30 pounds through the centre’s Cardiac Rehabilitation Program at Toronto Western Hospital (TWH) after having being diagnosed with an irregular heartbeat in August 2009.

“The cardiac rehab program was truly motivational. It opened my eyes to the number of people who have heart problems like me, and it was refreshing to know it came with a built-in support network,” says Walters, who notes work-related stress contributed to his weight gain and heart trouble. “I highly recommend a cardiac rehab program for anyone with a heart condition.”

Walters graduated from the program in April 2010, but continues to attend classes to keep the weight off.

Dr. Caroline Chessex, medical doctor and clinical director of the Cardiovascular Rehabilitation & Prevention Program at the centre, is part of a multidisciplinary team who treats patients like Walters by developing a personalized exercise program tailored to each patient’s cardiac risk profile.

“Our goal is to develop strategies for patients to reduce or eliminate their risk of coronary artery disease, prevent or minimize hospitalization, decrease mortality and improve quality of life,” says Chessex, noting that patients can prolong their life and reduce their risk of having a second heart attack, or needing a second heart surgery.

Beyond the physical and psychological benefits, cardiac rehabilitation saves money. Cardiac bypass surgery, the most common type of open-heart surgery, costs approximately $23,000 for each patient, but rehabilitation costs $1,000 to 1,500 per patient.

“The return on investment is obvious. Focusing on expensive cardiac interventions and then discharging patients without a systematic approach for support just doesn’t make sense,” says Grace.  “Cardiac rehab is the right step towards prevention and it saves money.”

The Canadian Institutes of Health Research (CIHR) and the  Heart and Stroke Foundation of Canada funded this study.