Author + information
- Received January 17, 2015
- Accepted February 26, 2015
- Published online May 19, 2015.
- Krishna G. Aragam, MD, MS∗∗ (, )
- Dadi Dai, PhD†,
- Megan L. Neely, PhD†,
- Deepak L. Bhatt, MD, MPH‡,
- Matthew T. Roe, MD, MHS†,
- John S. Rumsfeld, MD, PhD§ and
- Hitinder S. Gurm, MBBS‖
- ∗Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
- †Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- ‡Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- §Denver Veterans Affairs Medical Center, Denver, Colorado
- ‖Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
- ↵∗Reprint Requests and correspondence:
Dr. Krishna G. Aragam, Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, GRB 8-852, Boston, Massachusetts 02114.
Background Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients.
Objectives This study sought to determine the prevalence of and factors associated with referral to cardiac rehabilitation in a national PCI cohort, and to assess the association between insurance status and referral patterns.
Methods Consecutive patients who underwent PCI and survived to hospital discharge in the National Cardiovascular Data Registry between July 1, 2009 and March 31, 2012 were analyzed. Cardiac rehabilitation referral rates, and patient and institutional factors associated with referral were evaluated for the total study population and for a subset of Medicare patients presenting with acute myocardial infarction.
Results Patients who underwent PCI (n = 1,432,399) at 1,310 participating hospitals were assessed. Cardiac rehabilitation referral rates were 59.2% and 66.0% for the overall population and the AMI/Medicare subgroup, respectively. In multivariable analyses, presentation with ST-segment elevation myocardial infarction (odds ratio 2.99; 95% confidence interval: 2.92 to 3.06) and non–ST-segment elevation myocardial infarction (odds ratio: 1.99; 95% confidence interval: 1.94 to 2.03) were associated with increased odds of referral to cardiac rehabilitation. Models adjusted for insurance status showed significant site-specific variability in referral rates, with more than one-quarter of all hospitals referring <20% of patients.
Conclusions Approximately 60% of patients undergoing PCI in the United States are referred for cardiac rehabilitation. Site-specific variation in referral rates is significant and is unexplained by insurance coverage. These findings highlight the potential need for hospital-level interventions to improve cardiac rehabilitation referral rates after PCI.
The CathPCI Registry is an initiative of the American College of Cardiology Foundation and the Society for Cardiovascular Angiography and Interventions.
Dr. Bhatt is on the advisory board for Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is on the Board of Directors of the Boston VA Research Institute, Society of Cardiovascular Patient Care; is the Chair of the American Heart Association Get With The Guidelines Steering Committee; has received honoraria from the American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), and WebMD (Continuing Medical Education steering committees); is the Senior Associate Editor, Journal of Invasive Cardiology; is a member of the Data Monitoring Committees of Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and the Population and Health Research Institute; has received research grants from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi, and The Medicines Company; and has taken part in unfunded research at FlowCo, PLx Pharma, and Takeda. Dr. Roe has received research funding from Eli Lilly, Revalesio, Sanofi, American College of Cardiology, American Heart Association, and the Familial Hyperlipidemia Foundation; and has received consulting or honoraria from Eli Lilly, AstraZeneca, Sanofi, Janssen Pharmaceuticals, Merck, Regeneron, and Daiichi-Sankyo. Dr. Gurm has received research funding from the National Institutes of Health and the Agency for Health Care Research and Quality. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 17, 2015.
- Accepted February 26, 2015.
- 2015 American College of Cardiology Foundation