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