Sherry L Grace1,2,3, Kornelia Kotseva4,5, Mary A Whooley6,7. 1. Faculty of Health, York University, 4700 Keele Street, Toronto, Canada. sgrace@yorku.ca. 2. KITE-Toronto Rehabilitation Institute, Toronto, ON, Canada. sgrace@yorku.ca. 3. Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada. sgrace@yorku.ca. 4. National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland. 5. Imperial College Healthcare NHS Trust, London, UK. 6. US Department of Veterans Affairs Quality Enhancement Research Initiative, San Francisco, USA. 7. University of California, San Francisco, USA.
Abstract
PURPOSE OF REVIEW: Cardiac rehabilitation (CR) is grossly under-utilized. This review summarizes current knowledge about degree of CR utilization, reasons for under-utilization, and strategies to increase use. RECENT FINDINGS: ICCPR's global CR audit quantified for the first time the number of additional CR spots needed per year to treat indicated patients, so there are programs they may use. The first randomized trial of automatic/systematic CR referral has shown it results in significantly greater patient completion. Moreover, the recent update of the Cochrane review on interventions to increase use has provided unequivocal evidence on the significant impact of clinician CR encouragement at the bedside; a course is now available to train clinicians. The USA is leading the way in implementing automatic referral with inpatient-clinician CR discussions. Suggestions to triage patients based on risk to less resource-intensive, unsupervised program models could simultaneously expand capacity and support patient adherence.
PURPOSE OF REVIEW: Cardiac rehabilitation (CR) is grossly under-utilized. This review summarizes current knowledge about degree of CR utilization, reasons for under-utilization, and strategies to increase use. RECENT FINDINGS: ICCPR's global CR audit quantified for the first time the number of additional CR spots needed per year to treat indicated patients, so there are programs they may use. The first randomized trial of automatic/systematic CR referral has shown it results in significantly greater patient completion. Moreover, the recent update of the Cochrane review on interventions to increase use has provided unequivocal evidence on the significant impact of clinician CR encouragement at the bedside; a course is now available to train clinicians. The USA is leading the way in implementing automatic referral with inpatient-clinician CR discussions. Suggestions to triage patients based on risk to less resource-intensive, unsupervised program models could simultaneously expand capacity and support patient adherence.
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