Differences in Cardiac Rehabilitation Enrollment by Referral Setting

National guidelines have focused on increasing early referrals to cardiac rehabilitation (CR) before hospital discharge. However, patients often have not seen their cardiologists for a CR discussion, which may affect their willingness to enroll. This study compared the odds of enrollment between inpatient, outpatient, and dual (inpatient and outpatient) referrals.

A retrospective study was conducted on 1614 patients referred to CR within a university hospital system in Rhode Island from October 1, 2021 to September 30, 2022. Rates of CR enrollment were compared across inpatient (n = 807), outpatient (n = 670), and dual (n = 137) referral settings. Multivariable regression models, including demographics and comorbidities, were used to identify predictors of enrollment.

A total of 874 (54%) patients enrolled with 40% of patients with inpatient referrals enrolling compared to 70% and 60% of those with outpatient and dual referrals, respectively ( P < .005). The average time between referral to initial visit was 24.2 ± 20.0 days. Regression modeling showed that patients with outpatient (OR = 3.74: 95% CI, 2.97-4.72) and those with dual referrals (OR = 2.09: 95% CI, 1.44-3.05) had higher odds of enrolling than those with inpatient referrals. Additionally, patients >80 years had lower odds of enrolling (OR = 0.50: 95% CI, 0.36-0.71) compared to younger patients.

Patients with outpatient referrals and dual referrals had greater odds of CR enrollment compared to those with inpatient referrals. Older patients (age >80 years) had lower odds of enrollment compared to those aged 50 to 65 years. Studies should focus on how to strengthen the inpatient CR referral process and tailor the CR discussion to meet older patient needs.