Performance Measures for Cardiac Rehabilitation - An Opportunity to Bridge an Important Treatment Gap

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Abstract

In spite of growing scientific evidence of the benefits of cardiac rehabilitation and secondary prevention programs, these programs remain underutilized, with fewer than 30% of eligible patients participating. This occurs despite evidence that participation in cardiac rehabilitation is associated with a mortality benefit of approximately 20–25%.1 Although barriers to participation are multifaceted, a major first step is to correct problems with initial referral and to standardize the level of care provided to patients enrolled in cardiac rehabilitation. With this in mind, a writing committee combining experts from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) recently published a set of performance measures related to referral to cardiac rehabilitation and to delivery of cardiac rehabilitation and secondary prevention services. This article will summarize those recommendations, including the rationale and evidence base for these measures.

Citation
US Cardiology, 2007;4(2):60-2

Pages

In spite of growing scientific evidence of the benefits of cardiac rehabilitation and secondary prevention programs, these programs remain underutilized, with fewer than 30% of eligible patients participating. This occurs despite evidence that participation in cardiac rehabilitation is associated with a mortality benefit of approximately 20–25%.1 Although barriers to participation are multifaceted, a major first step is to correct problems with initial referral and to standardize the level of care provided to patients enrolled in cardiac rehabilitation. With this in mind, a writing committee combining experts from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) recently published a set of performance measures related to referral to cardiac rehabilitation and to delivery of cardiac rehabilitation and secondary prevention services. This article will summarize those recommendations, including the rationale and evidence base for these measures.

Definition of Cardiac Rehabilitation and Secondary Prevention Programs

When first developed over three decades ago, cardiac rehabilitation programs were supervised inpatient and outpatient exercise training programs for the physical rehabilitation of patients following a myocardial infarction or coronary artery bypass graft surgery. In recent years, cardiac rehabilitation programs have evolved into ‘secondary prevention’ centers that deliver a wide array of services aimed at both the rehabilitation of patients with significant cardiovascular diseases and the provision of preventive therapies to reduce the risk of recurrent cardiovascular disease events.
The writing committee used the US Public Health Service (PHS) definition of cardiac rehabilitation: “Cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk-factor modification, education, and counseling. These programs are designed to limit the physiological and psychological effects of cardiac illness, reduce the risk of sudden death or re-infarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients.”2

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References
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