Hongwei Liu1, Stephen B Wilton2, Danielle A Southern3, Merril L Knudtson4, Andrew Maitland4, Trina Hauer5, Ross Arena6, Codie Rouleau7, Matthew T James8, James Stone9, Sandeep Aggarwal10. 1. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: liuh@ucalgary.ca. 2. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; TotalCardiology Research Network, Calgary, Alberta, Canada. 3. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. 4. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada. 5. TotalCardiology Research Network, Calgary, Alberta, Canada; TotalCardiology Rehabilitation, Calgary, Alberta, Canada. 6. TotalCardiology Research Network, Calgary, Alberta, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA. 7. TotalCardiology Research Network, Calgary, Alberta, Canada; TotalCardiology Rehabilitation, Calgary, Alberta, Canada; Department of Psychology, University of Calgary, Calgary, Alberta, Canada. 8. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 9. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; TotalCardiology Research Network, Calgary, Alberta, Canada. 10. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; TotalCardiology Research Network, Calgary, Alberta, Canada; TotalCardiology Rehabilitation, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Cardiac rehabilitation (CR) is a guideline-indicated modality for reducing residual cardiovascular risk among patients undergoing coronary artery bypass grafting (CABG) surgery. However, many referred patients do not initiate or complete a CR program; even more patients are never even referred. METHODS: All post-CABG patients in Calgary, Alberta, Canada, from January 1, 1996, to March 31, 2016, were included. Data were obtained from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiology Rehabilitation databases. Automated referral to CR at discharge after CABG was instituted on July 1, 2007. We used interrupted time series analysis to evaluate the impact of automated referral on CR referral and completion rates and studied the association of these CR process markers with mortality. RESULTS: A total of 8,118 patients underwent CABG surgery during the study period: 5,103 before automation and 3,015 after automation. Automation increased referral rates from 39.5% to 75.0% (P < 0.001). Automated referral was associated with a 7.2% increase in CR completion in the overall population (33.3% vs 26.1%; P < 0.001). In adjusted models, CR referral alone was not associated with reduced mortality (hazard ratio [HR] 0.84, 95% CI 0.64-1.11), but CR completion was (HR 0.43, 95% CI 0.31-0.61). CONCLUSION: Automated referral in post-CABG patients resulted in modest improvement in CR program completion. Therefore, even when CR referral is automated to include all eligible patients, additional strategies to support CR program enrollment and completion remain necessary to achieve the desired health benefits.
BACKGROUND: Cardiac rehabilitation (CR) is a guideline-indicated modality for reducing residual cardiovascular risk among patients undergoing coronary artery bypass grafting (CABG) surgery. However, many referred patients do not initiate or complete a CR program; even more patients are never even referred. METHODS: All post-CABG patients in Calgary, Alberta, Canada, from January 1, 1996, to March 31, 2016, were included. Data were obtained from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiology Rehabilitation databases. Automated referral to CR at discharge after CABG was instituted on July 1, 2007. We used interrupted time series analysis to evaluate the impact of automated referral on CR referral and completion rates and studied the association of these CR process markers with mortality. RESULTS: A total of 8,118 patients underwent CABG surgery during the study period: 5,103 before automation and 3,015 after automation. Automation increased referral rates from 39.5% to 75.0% (P < 0.001). Automated referral was associated with a 7.2% increase in CR completion in the overall population (33.3% vs 26.1%; P < 0.001). In adjusted models, CR referral alone was not associated with reduced mortality (hazard ratio [HR] 0.84, 95% CI 0.64-1.11), but CR completion was (HR 0.43, 95% CI 0.31-0.61). CONCLUSION: Automated referral in post-CABG patients resulted in modest improvement in CR program completion. Therefore, even when CR referral is automated to include all eligible patients, additional strategies to support CR program enrollment and completion remain necessary to achieve the desired health benefits.