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Refer heart patients before leaving hospital
Healthcare practitioners can increase the number of patients with heart disease referred to a cardiac rehabilitation program by 40%, helping them to reduce their risk of dying and improve their quality of life, say researchers at the Peter Munk Cardiac Centre at Toronto General Hospital in Canada.
Previous studies, including one by Taylor in 2004, indicate that participating in cardiac rehab after a cardiac illness, such as a heart attack, can reduce the risk of death by approximately 25%, a reduction similar to that of other standard therapies such as statins and aspirin. In spite of this evidence, only 20-30% of patients are referred to a cardiac rehabilitation program after hospital discharge, a phenomenon observed in many countries.
Researchers at the Peter Munk Cardiac Centre explored multiple strategies to increase referrals to cardiac rehabilitation programs at 11 hospitals across Ontario, including using a discharge checklist for doctors and allied health professionals, electronic referral in medical records, and a talk with patients at the bedside. According to the study, "Effect of Cardiac Rehabilitation Referral Strategies on Utilization Rates," published in the Feb. 14 edition of the Archives of Internal Medicine, a combined approach a checklist or electronic referral and talking with patients can increase referrals by 45%. By targeting both healthcare providers and patients, more than 70% of eligible patients enroll in cardiac rehab.
"Every patient discharged from the hospital with a heart condition should be referred to a cardiac rehab program," says Sherry Grace, PhD, principal investigator and director of research for the Cardiovascular Rehabilitation and Prevention Program at the Peter Munk Cardiac Centre, University Health Network. "Cardiac rehab is a key component of the continuum of cardiac care. We shouldn't just discharge patients from the hospital without ensuring there is a link to these proven rehab services to support patients in their recovery." Grace is also an associate professor in the School of Kinesiology & Health Science at York University in Toronto.
Cardiac rehabilitation offers a comprehensive approach to health by combining medical treatments and lifestyle modification. Patients are able to benefit from services including education sessions; nutritional assessment with a dietician; risk factor treatment (hypertension, cholesterol, and smoking cessation) by physicians and nurse practitioners; medication review with a pharmacist; targeted exercise prescription by an exercise physiologist, nurse, or kinesiologist; and supervised exercise.
Dr. Caroline Chessex, clinical director of the Cardiovascular Rehabilitation and Prevention Program at the Peter Munk Cardiac Centre, is part of a multidisciplinary team who treats patients such as Walters by developing a personalized exercise program tailored to each patient's cardiac risk profile. "Our goal is to develop strategies for patients to reduce or eliminate their risk of coronary artery disease, prevent or minimize hospitalization, decrease mortality, and improve quality of life," says Chessex, noting that patients can prolong their life and reduce their risk of having a second heart attack or needing a second heart surgery.
Cardiac rehabilitation also saves money. Cardiac bypass surgery costs approximately $23,000 for each patient, but rehabilitation costs $1,000-1,500 per patient. "The return on investment is obvious. Focusing on expensive cardiac interventions and then discharging patients without a systematic approach for support just doesn't make sense," says Grace. "Cardiac rehab is the right step toward prevention, and it saves money."
The Canadian Institutes of Health Research (CIHR) and Heart and Stroke Foundation funded this study.