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  • Study: Listen to the CPGs—Cardiac Rehab Works

    The clinical practice guidelines are right: Ambulatory cardiac rehabilitation (CR) should be routine for patients with cardiovascular events such as myocardial infarction, say authors of a study in the European Heart Journal (abstract only available for free). However, despite evidence of its effectiveness—including a nearly 50% drop all-cause mortality for patient who receive CR—CR “remains significantly underused,” they write.

    Authors compared the long-term outcomes of an early discharge CR program for patients with ST-elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, planned percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) versus no CR at all. At one hospital, all 839 patients received early CR; at a second, none of the 441 patients received CR, as it was not available. The hospitals were in the same geographic area.

    The CR program included evaluations, cycle-ergometer tests, and echocardiograms for all patients. Patients with STEMI or CABG received 5 weeks of exercise bicycle training followed by 6 weeks of gym training, supervised by a nurse and a physical therapist. The program was tailored to each patient’s needs.

    After a 5-year follow-up period, researchers analyzed the data to account for confounding demographic variables and found:

    • All-cause mortality in the CR group was lower (10%) compared to the non-CR group (19%).
    • Cardiovascular mortality was 2% for the CR group and 7% for the non-CR group.
    • Hospitalization for cardiovascular causes was lower for the CR group (11% for the CR group, 25% for the non-CR group).
    • Combined hospitalization for cardiovascular causes and cardiovascular mortality was 13% for the CR group, compared with 29% for the non-CR group.

    Authors think that the CR method used for their study "can be adopted without the use of expensive resources and can be applied in any ambulatory CR center," thus making it easier for CR to become more widespread.

    And it's that the lack of widespread use of CR that's the problem, they note.

    "Despite these evidences supporting the benefits of CR programs, this service is greatly underutilized, especially by women, elderly, and diabetic patients," authors write. "Referral and participation range is between 30% and 50% in Europe and it is around 25% in [the United States]."

    Comments

    • I like the article very much. There is a growing need for cardiac rehabilitation with physical therapists playing a vital role. I am interested in starting a cardiac rehab unit at our institution but am unsure of reimbursement.

      Posted by Anand on 8/29/2018 4:45 PM

    • I would love to find more CEUs covering cardiac rehab.

      Posted by Meshell on 8/29/2018 5:29 PM

    • Great Article. Continued evidence showing the importance of CR. Policies need to change to allow this service to be better utilized by the public.

      Posted by Jeremy Voorhees PT CCRP on 8/29/2018 6:01 PM

    • I would love more CEUs regarding cardiac rehab as well as more information regarding cardiac rehab in patients with congenital heart disease.

      Posted by Olivia on 8/30/2018 11:09 AM

    • I started a cardiac rehab program back in 1981-it started with acute and moved to outpatient. After a few years I started the Pulm and Diabetic component. CR has always been under utilized but the outcomes are are very strong showing the benefit of this type of program. PTs were involved back then but they moved out of it in the late 80's Glad to see a lot of interest!!!.

      Posted by MJ on 8/30/2018 4:17 PM

    • If you are not a hospital-based outpatient CR program, reimbursement is an issue. But there is a work around using PT services for people who do not live within a reasonable distance of a CR program. Wouldn't it be nice to have a course that focused on how any PT office could be educated and set up to work with CR individuals!

      Posted by Linda Gilham -> AGR`= on 8/31/2018 10:16 AM

    • They need to figure out a better reimbursement deal before this will ever take off again with Medicare for bath phase I and II. I thought we’d have it with the bundle aystem last year but that was bad politics all rolled up with the CJR bundle. We have a program and making ends meet and justification is an ongoing process all the time despite the great results.

      Posted by Steve on 9/2/2018 11:30 AM

    • I am seeking information on a physical therapist’s roll in cardiac rehab as I am finding lots on exercise physiologist’s lead roll in CR. We are looking into starting a pediatric cardiac rehab program and hitting walls on finding research/supportive evidence.

      Posted by Sara Anderson on 10/22/2018 12:17 AM

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