Promoting Cardiac Rehabilitation in Acute Coronary Syndrome Patients: Quality Initiative Based on Education,...

Area of Science:

• Cardiology
• Public Health
• Quality Improvement

Background:

• Cardiac rehabilitation is a Class I recommendation for acute coronary syndrome (ACS) patients.
• National referral rates for cardiac rehabilitation are low, with fewer than 1 in 5 ACS patients referred.
• Low referral rates persist even within institutional settings.

Purpose of the Study:

• To enhance the referral rate of post-ACS patients to cardiac rehabilitation.
• To increase the participation of post-ACS patients in cardiac rehabilitation programs.
• To evaluate the effectiveness of a quality improvement initiative on referral and participation rates.

Main Methods:

• A quality improvement initiative was implemented for inpatient cardiology services.
• The initiative included patient and staff education, automated referral orders, and multidisciplinary rounds with cardiac rehabilitation staff.
• Referral rates, pre-discharge appointment scheduling, and program attendance were compared before and after the intervention.

Main Results:

• The proportion of ACS patients referred to cardiac rehabilitation before discharge increased from 10% to 43% (P < 0.001).
• The mean number of patients with scheduled pre-discharge appointments rose from 2 to 5 (P < 0.001).
• The mean number of patients attending their appointments increased from 1 to 3 (P = 0.001).

Conclusions:

• A multifaceted quality improvement initiative effectively increased cardiac rehabilitation referrals for post-ACS patients.
• Automated referrals, patient education, and staff engagement significantly improved appointment scheduling and attendance.
• The intervention demonstrated sustained improvements in referral and participation rates, addressing a critical gap in post-ACS care.