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  • Researchers Say Cardiac Rehab Not Reaching Enough People

    Even though cardiac rehabilitation (CR) is strongly supported as an intervention for patients who have suffered a heart attack, too few people are getting referrals for CR programs, and an even smaller number is actually following through once they get a referral, according to a research letter recently published in JAMA.

    Authors looked at CR enrollment and participation rates by comparing Medicare records of 58,269 acute myocardial infarction (AMI) patients with a national registry of coronary treatment intervention outcomes (National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Registry). They found that between 2007 and 2010, only 64.2% of AMI patients were referred to CR at the time of hospital discharge, and only 12,000 of those patients attended at least 1 CR session during the following year.

    Broken down in another way, the rates of CR referral and engagement are even more disappointing: according to the researchers, among all patients included in the study, only 23.1% attended at least 1 CR session. Just 5.4% completed 36 sessions or more—the number of sessions typically covered by health insurance.

    The situation leaves health policy leaders and health care providers with a twofold challenge, according to authors of the letter.

    "Quality improvement efforts should focus not only on increasing referral rates but also on addressing barriers to attending rehabilitation sessions, such as travel distance, copayments, and lack of coordination between inpatient and outpatient clinicians," they write. "Alternative methods of providing [CR], such as home-based programs, may be needed to improve participation rates."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • We have an excellent Cardio-pulmonary rehab program here in Greenville North Carolina; however, there are no PT's involved in the program other than to initiate consults from our practice settings. Thanks.

      Posted by Glen Newman on 8/12/2015 5:28 PM

    • Physical Therapists are trained in exercise prescription and in cardiac rehab principles. In DPT programs we teach the student to read an EKG as effectively as most other medical professionals who have similar skills. We teach students the ACSM Guidelines for exercise testing and prescription. We teach the student how to monitor the patient's tolerance of an exercise load by using blood pressure, heart rate, the Borg Scale, EKG monitoring and the attention to the patient's subjective symptoms. The student is familiar with the standard laboratory blood values and a host of other widely available data by which a patient can be monitored. However, when most students graduate and enter practice, there seems to be a generalized forgetting of all that they have learned in cardiopulmonary. The evidence for this is appalling - i.e. - the monitoring of neurologically obtunded patients decays to the point that most clinics never even bother to take a blood pressure to determine if the patient is struggling during an exercise session. There are virtually no clinics that monitor a patient's exercise experience with an EKG machine. How can we ever hope to increase the patient's exposure to cardiac rehab if we never put into practice the principles of cardiac rehab that we were taught? After 40 years of begging my fellow PTs to use the Borg Scale, or to use a blood pressure cuff and a stethoscope for minimal screening, I have yet to see any movement toward a more thoughtful practice in this regard. It is simply incomprehensible that this lazy approach to patient monitoring still goes on. Perhaps if we were to be sued in court more often for failing to monitor our patients correctly would this shameful and neglectful attention to the patient's safety be ended. For the dire4ctor's of PT clinics, I have a question. How is it that you are willing to spend large sums of money for exercise equipment that enhances your ability to exercise the patient while at the same time you will not even spend a dime in purchasing a small EKG unit to assess your patient's cardiac response to the UBE or the Nu-Step or to a cycle ergometer? Why? I do not understand the professions complete lethargy in this area!!!

      Posted by David A. Arnall on 8/13/2015 7:57 AM

    • I disagree with Glenn. As a clinical Exercise Physiologist, I feel me and Ep''s are more proficient in treating cardiac patents . Glenn states that PT students are trained to read EKGs,etc. Working at a large hospital specializing in cardiac stress testing/cardiac rehab PT''s are not used. Are they proficent in diagnosing a left bundle branch block baseline, considering ST depression, probably not. In orderived for a PT to be proficient in cardiac rehab, they must have skills in telemetry, icu. Most PTS do not have that

      Posted by Chris on 3/17/2017 9:05 PM

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