Society position statementSystematizing Inpatient Referral to Cardiac Rehabilitation 2010: Canadian Association of Cardiac Rehabilitation and Canadian Cardiovascular Society Joint Position Paper: Endorsed by the Cardiac Care Network of Ontario
Section snippets
Objectives and Methods
The objective of this policy position is to synthesize evidence and make recommendations on strategies to increase patient enrollment in CR. Comprehensive literature searches of Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and the Cochrane Library databases were conducted to identify eligible peer-reviewed articles. The search strategy for each database consisted of 4 themes: (1) CVDs, (2) rehabilitation, (3) referral, and (4) enrollment. Articles were included in the review if they met the
Conclusions
Despite the proven benefits of CR,3 only an average of 34% of eligible patients are referred,55 and 20% ultimately enroll.21 This trend runs counter to evidence-based clinical practice guidelines, which recommend CR as the standard of care in the management of CVD.27 Based on the evidence synthesized through the development of this policy position, we strongly suggest that to increase CR enrollment, a combination of systematic and liaison referral strategies be implemented for all inpatient
Acknowledgements
We gratefully acknowledge Shannon Gravely-Witte, MSc, who performed the systematic review of the literature and undertook quality assessment in accordance with the grading of recommendations assessment, development, and evaluation (GRADE) system, and Yvonne Leung, MA, who undertook the meta-analysis. The authors are grateful to Marilyn Thomas, Carolyn Pullen, Michelle Graham, MD, and Michael McDonald, MD, for their support in the preparation of this document. We also acknowledge the Secondary
References (55)
- et al.
The Canadian Heart Health Strategy and Action Plan: cardiac rehabilitation as an exemplar of chronic disease management
Can J Cardiol
(2010) - et al.
Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials
Am J Med
(2004) Current status of cardiac rehabilitation
J Am Coll Cardiol
(2008)- et al.
Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries
Lancet
(2009) - et al.
Economic evaluation of cardiac rehabilitation soon after acute myocardial infarction
Am J Cardiol
(1993) - et al.
Continuity of cardiac care: cardiac rehabilitation participation and other correlates
Int J Cardiol
(2007) - et al.
Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management
Can J Cardiol
(2006) - et al.
Universal access: but when? treating the right patient at the right time: access to cardiac rehabilitation
Can J Cardiol
(2006) - et al.
Cardiac rehabilitation after myocardial infarction in the community
J Am Coll Cardiol
(2004) - et al.
Testing an intervention to increase cardiac rehabilitation enrollment after coronary artery bypass grafting
Am J Cardiol
(2001)
Cardiac rehabilitation II: referral and participation
Gen Hosp Psychiatry
AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services
J Am Coll Cardiol
ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 2002 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J Am Coll Cardiol
Increasing attendance at a cardiac rehabilitation programme: an intervention study using the theory of planned behaviour
Coronary Health Care
Determinants of referral to cardiac rehabilitation programs in patients with coronary artery disease: a systematic review
Am Heart J
Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention: Translating Knowledge Into Action
Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials
JAMA
Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients
BMJ
Optimal medical therapy with or without PCI for stable coronary disease
N Engl J Med
Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial
Circulation
Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes
Circulation
Meta-analysis: secondary prevention programs for patients with coronary artery disease
Ann Intern Med
The Canadian Heart Health Strategy: Risk Factors and Future Cost Implications
Economic evaluation of cardiac rehabilitation: a systematic review
Eur J Cardiovasc Prev Rehabil
Exercise-Based Cardiac Rehabilitation Programs for Coronary Artery Disease: A Systematic Clinical and Economic Review
The relationship between need and capacity for multidisciplinary cardiovascular risk-reduction programs in Ontario
Can J Cardiol
Use of cardiac rehabilitation by medicare beneficiaries after myocardial infarction or coronary bypass surgery
Circulation
Cited by (76)
Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline
2022, Canadian Journal of CardiologyCitation Excerpt :However, physicians can also be a hindrance to referral, such as when they inform patients they are “too well” or “too sick” to be appropriate CR candidates.34,35 Although women might seek out their own referrals if they are aware of CR services,34,36,37 research and guidelines recommend the institution of automated/systematic referral, which overcomes sex biases.38,39 Increased education of physicians and other health care providers is needed to raise awareness of the importance of CR, as well as the indications, exercise contraindications, and safety of CR programs.34
National Trends of Gender Disparity in Canadian Cardiovascular Society Guideline Authors, 2001-2020
2021, CJC OpenCitation Excerpt :The percentage of women serving as the chair or cochair of the CCS guideline committee was significantly less than that of men (20.1% women, 79.8% men, P < 0.0001). Women were appointed as the chair or cochair for only 15 guidelines (Table 2).15-17,19,20,28-36 Women were appointed to cochair with a man on 12 guideline committees.15-17,19,20,28-32,36
Sex, Depression, and More in Cardiac Rehabilitation
2021, Canadian Journal of CardiologyMore Evidence of Comprehensive Cardiac Rehabilitation Benefits, Even for All-Cause Mortality: Need to Increase Use Worldwide
2021, Canadian Journal of CardiologyTherapies for Advanced Heart Failure Patients Ineligible for Heart Transplantation: Beyond Pharmacotherapy
2020, Canadian Journal of Cardiology
The disclosure information of the authors and reviewers is available from the CCS on the following Web sites: www.ccs.ca and www.ccsguidelineprograms.ca.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgment in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available, and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.