Author + information
- Krishna G. Aragam,
- Dadi (David) Dai,
- Megan Neely,
- Deepak Bhatt,
- Matthew Roe,
- John Rumsfeld and
- Hitinder Gurm
Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) remain low despite strong evidence that rehabilitation is associated with lower mortality in PCI patients. We determined the prevalence of, and factors independently associated with referral to cardiac rehabilitation at the national level.
Cardiac rehabilitation referral rates and factors associated with referral were assessed in 1,432,399 patients undergoing PCI and surviving to hospital discharge at 1,310 hospitals participating in the National Cardiovascular Data Registry between 2009 and 2011. Multivariable logistic regression analysis was performed with generalized estimating equations to account for within-hospital clustering.
The 3-year referral rate was 59.2%. The median referral rate among all sites was 65.2% (interquartile range 71.3%). Selected characteristics of patients who were and were not referred are shown in Table 1. In multivariable analyses, presentation with acute myocardial infarction and private insurance were associated with increased referral. Older age, diabetes, peripheral artery disease, prior PCI, prior CABG, and lack of insurance were associated with decreased referral.
Over 40% of PCI patients in the United States are not referred to cardiac rehabilitation. Acute presentation is associated with increased referral, while older age, several co-morbidities, and lack of insurance are associated with decreased referral.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Appropriateness and Gaps in Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1116-109
- 2013 American College of Cardiology Foundation