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Broken Hearts Need Work Too: Increasing Participation in Cardiac Rehabilitation Post Cardiac Event
Heather ChristensenKinesiology Major
California State University – Monterey Bay
Today’s Healthcare Professionals
American Detriment1 in 3 Americans have cardiovascular disease
(CVD)
Billions of dollars in healthcare costs
Cardiac rehabilitation (cardiac rehab) is cheap
Cardiac rehab works
Hurdles to Heart HealthLack of referrals
Under referred populationsPhysician support = Patient participation
Patient BarriersApproximately 40% attend cardiac rehab
(Farley et al., 2003, p. 208)Patients feel they can ‘deal with it on their
own’
Factors Associated with Limited Referral and Enrollment in Cardiac Rehabilitation/Secondary Prevention Programs (CR/SPP) Patient Oriented Factors
Female sex Older age Race/ethnic minority group Low socioeconomic status Low educational attainment Low self-efficacy Low health literacy Lack of perceived need for
CR/SPP Work related factors (job
flexibility, loss of salary, self employment, and lack of healthcare/disability benefits)
Limited social support Home responsibilities
Medical Factors Multiple comorbidities including
depression and musculoskeletal conditions
Healthcare System Factors Lack of referral Lack facilitation of enrollment
after referral Strength of the endorsement of
CR/SPP by the patients physician Program availability and
characteristics Lack of program that serves specific
geographic areas, including rural areas and low-income communities
Distance of CR/SPP for patient’s home Hours of operation Parking and public transportation
access
Table adapted from: Balady, G., Ades, P., Bittner, V., Franklin, B., Gordon, N., Thomas, R.,…Yancy, C., (2011). Referral enrollment and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A presidential advisory from the American Heart Association. Circulation. 124. 2952. doi: 10.1161/CIR.0b013e31823b21e2
Eligible Patients
Non Referred Eligible Patients
Non Referred and Non Attending Eligible Patients
2 in 10 Eligible Patients Participating
Beneficial Outcomes of Proper Cardiac CarePhysical
impairments/ Morbidity/ Cardiac event risksFocus on exerciseCardiac rehab
better than drugs (Farley et al. 2003, p. 205)
BENEFITS OF EXERCISE OUTWEIGHT RISKS!!!
Beneficial Outcomes of Proper Cardiac CareQuality of Life (QOL)
Cardiac rehab goals: Increase “functional capacity” Older adults “reduce frailty” (Dorosz, 2009, p.
726)Reemployment
35% do not return to workProgram design could increase
reemploymentDecrease burden on society
Promoting the Means to a Better LifeSystematic Referral plus Liaison
Increase referral of females, minorities, and low socioeconomic populations
Referral + liaison= 66% increase in enrollment
Health team support and enthusiasm
Options: Home based vs. Center basedHome based program effective and safe
We Can Increase Utilization of Cardiac Rehab by:
1. Promoting the use of systematic referral
2. Advocating cardiac rehab to heart patients
3. Understanding options
Thank You!!
Questions/Comments
ReferencesBalady, G., Ades, P., Bittner, V., Franklin, B., Gordon, N., Thomas, R.,
Tomaselli, G., & Yancy, C. (2011). Referral, enrollment and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A Presidential advisory from the American Heart Association. Circulation, 124, 2951-2960. doi:10.1161/CIR.0b013e31823b21e2
Dorosz, J. (2009). Updates in cardiac rehabilitation. Physical Medicine and Rehabilitation Clinics of North America. 20. 719-736. doi: 10.1016/j.pmr.2009.06.006
Farley, R., Wade, T., & Birchmore, L. (2003). Factors influencing attendance at cardiac rehabilitation among coronary heart disease patients. European Journal of Cardiovascular Nursing, 2, 205-212. doi:10.1016/S1474-5151(03)00060-4
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