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Updated: May 23, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Differences in Cardiac Rehabilitation Enrollment by Referral Setting
Kevin Chen1, Julianne DeAngelis, Dana Antinozzi
1Author Affiliations: Warren Alpert Medical School of Brown University, Providence, Rhode Island (Drs Chen, Berkowitz, and Wu); Department of Medicine, Rhode Island Hospital, Providence, Rhode Island (Dr Berkowitz); Division of Cardiology, Department of Medicine, VA Medical Center, Providence, Rhode Island (Dr Wu); Brown University School of Public Health, Providence, Rhode Island (Ms Antinozzi); and Center for Cardiac Fitness, The Miriam Hospital, Providence, Rhode Island (Ms DeAngelis, Dr Kerwin, and Dr Wu).
Insights
Outpatient and dual referrals significantly increase cardiac rehabilitation (CR) enrollment compared to inpatient referrals. Older patients (>80 years) show lower CR enrollment rates, suggesting a need for tailored strategies.
Area of Science:
- Cardiology
- Public Health
- Healthcare Management
Background:
- National guidelines emphasize early cardiac rehabilitation (CR) referrals before hospital discharge.
- Patient willingness to enroll in CR may be influenced by prior discussions with cardiologists.
- This study investigates enrollment rates based on referral type: inpatient, outpatient, and dual.
Purpose of the Study:
- To compare the odds of cardiac rehabilitation (CR) enrollment based on inpatient, outpatient, and dual referral settings.
- To identify factors influencing CR enrollment among referred patients.
- To inform strategies for improving CR uptake.
Main Methods:
- Retrospective study of 1614 patients referred to CR from October 2021 to September 2022.
- Comparison of CR enrollment rates across inpatient (n=807), outpatient (n=670), and dual (n=137) referral groups.
- Multivariable regression analysis to determine predictors of enrollment, controlling for demographics and comorbidities.
Main Results:
- Overall enrollment rate was 54% (874/1614 patients).
- Outpatient referrals (70%) and dual referrals (60%) had significantly higher enrollment rates than inpatient referrals (40%).
- Patients >80 years had lower odds of enrollment (OR=0.50) compared to younger patients.
Conclusions:
- Outpatient and dual referrals are associated with greater odds of CR enrollment than inpatient referrals.
- Older patients (>80 years) are less likely to enroll in CR.
- Future research should focus on enhancing inpatient CR referral processes and tailoring CR discussions for older adults.
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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