Older MI Survivors Missing Out on Cardiac Rehab

The same question needs to be asked about older stroke survivors. But we have no great stroke association that will follow up on even simple questions like these. Stroke survivors have NO support, we have to do absolutely everything on our own.  Hospitals should be publicizing this rate for strokes and cardiac issues if they cared about patients.

Older MI Survivors Missing Out on Cardiac Rehab

Barely 5% of older heart attack survivors eligible for cardiac rehabilitation actually completed a rehab program, authors of a large registry study reported in JAMA Internal Medicine.

To determine referral and participation rates for cardiac rehabilitation, Jacob Doll, MD, of Duke University, and colleagues used data from the ACTION Registry-GWTG, a national quality improvement registry capturing data on myocardial infarction patients treated at U.S. ho
The researchers gathered information from the registry on more than 58,000 patients 65 or older presenting with AMIs and eligible for cardiac rehabilitation from 2007 through 2010. They then linked this information to Medicare claims data.

Key findings included the following:

• Of the 58,269 eligible patients, 36,376 (62.4%) were referred for cardiac rehabilitation
• 13,657 patients (23.4%) attended at least one session
• 3,175 patients (5.4%) completed 36 sessions or more

"Cardiac rehabilitation improves survival after AMI [acute myocardial infarction] and is associated with improvements in lifestyle, functional capacity, and quality of life for older adults. Despite these benefits, rates of referral and participation have traditionally been low, especially among older adults," the researchers wrote in a research letter.

Cardiac rehabilitation programs include individualized exercise regimens, health education, and structured support focused on cardiovascular risk reduction and medication adherence. Patients typically attend 2 to 3 sessions per week at a designated center for a total of 36 sessions.

One way to boost these numbers would be to make cardiac rehabilitation programs more convenient and accessible for patients, Doll and colleagues wrote.

   

"Hospitals have developed automatic referral systems that are integrated into the electronic health record and provide reminders to physicians. These systems are important, but clinicians and health systems should move beyond referral to develop ways to bridge the gap between referral and attendance," Doll told MedPage Today via email.

"At minimum, physicians should discuss cardiac rehabilitation at follow-up clinic appointments, and emphasize the importance of attendance," Doll said.

"Quality improvement efforts should focus not only on increasing referral rates but also on addressing barriers to attending rehabilitation sessions, such as travel distance, copayments, and lack of coordination between inpatient and outpatient clinicians," the researchers wrote.

"Alternative methods of providing cardiac rehabilitation, such as home-based programs, may be needed to improve participation rates," the researchers concluded.

The researchers gathered information from the registry on more than 58,000 patients 65 or older presenting with AMIs and eligible for cardiac rehabilitation from 2007 through 2010. They then linked this information to Medicare claims data.

Key findings included the following:

• Of the 58,269 eligible patients, 36,376 (62.4%) were referred for cardiac rehabilitation
• 13,657 patients (23.4%) attended at least one session
• 3,175 patients (5.4%) completed 36 sessions or more

"Cardiac rehabilitation improves survival after AMI [acute myocardial infarction] and is associated with improvements in lifestyle, functional capacity, and quality of life for older adults. Despite these benefits, rates of referral and participation have traditionally been low, especially among older adults," the researchers wrote in a research letter.

Cardiac rehabilitation programs include individualized exercise regimens, health education, and structured support focused on cardiovascular risk reduction and medication adherence. Patients typically attend 2 to 3 sessions per week at a designated center for a total of 36 sessions.

One way to boost these numbers would be to make cardiac rehabilitation programs more convenient and accessible for patients, Doll and colleagues wrote.

"Hospitals have developed automatic referral systems that are integrated into the electronic health record and provide reminders to physicians. These systems are important, but clinicians and health systems should move beyond referral to develop ways to bridge the gap between referral and attendance," Doll told MedPage Today via email.

"At minimum, physicians should discuss cardiac rehabilitation at follow-up clinic appointments, and emphasize the importance of attendance," Doll said.

"Quality improvement efforts should focus not only on increasing referral rates but also on addressing barriers to attending rehabilitation sessions, such as travel distance, copayments, and lack of coordination between inpatient and outpatient clinicians," the researchers wrote.

"Alternative methods of providing cardiac rehabilitation, such as home-based programs, may be needed to improve participation rates," the researchers concluded.