Cardiology resident London Health Sciences Centre London, Ontario, Canada
Background: Cardiac rehabilitation (CR) improves patients’ morbidity and mortality. Following the COVID-19 pandemic, St. Joseph’s Cardiac Rehabilitation and Secondary Prevention program (CRSP) experienced a significant decline in referral rates. This decline was despite preserved numbers of acute coronary syndrome (ACS), coronary artery bypass graft surgeries (CABG), and valvular interventions completed. An electronic medical record (EMR)-based discharge order set including automatic CR referral was implemented, but referral rates have yet to recover. The objective of this study was to identify eligible patients that were not referred and their characteristics.
METHODS AND RESULTS:
Methods: This retrospective chart review compared CRSP-referred and non-referred patients discharged from cardiology and cardiovascular surgery at London Health Sciences Centre (LHSC) between September 1, 2022 and February 28, 2023. Patient demographics, hospitalization characteristics, and CR referral status were collected. Statistical analysis was performed with significance value of p< 0.05 and logistic regression modelling was done for significant variables.
Results: A total of 410 patients were referred and 648 patients were not referred to CRSP. Twenty-one percent of eligible patients had a missed referral and were hospitalized for either congestive heart failure (CHF) (45%), cardiac surgeries (27%), and ACS (19%). Eligible CR patients were more likely not to be referred if they were older, female, use a walker, discharged from a cardiology ward service, discharged by an internal medicine resident, and or hospitalized with CHF. In contrast, successfully referred individuals were more likely to be discharged from the Coronary Care Unit (CCU), discharged by a cardiology resident or staff, and or admitted for ACS for which they received percutaneous coronary intervention (PCI). Logistic regression models demonstrated factors with the highest odds ratio for non-referral included hospitalization for CHF or Takotsubo cardiomyopathy, ambulating with a walker, and being admitted to a cardiology service other than CCU.
Conclusion: Over 20% of cardiac patients discharged from LHSC are missing the opportunity for CR referral, largely from failed recognition of potential benefit. Older women hospitalized for CHF on the cardiology ward were shown to have the greatest odds of not being referred. To improve CR referral rates, educating internal medicine residents on overall CR benefits for ACS and CHF patients may help remedy the referral gap.
