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Early scheduling gets more patients to cardiac rehab

By Andrew M. Seaman

NEW YORK (Reuters Health) - Scheduling heart patients' first cardiac rehabilitation session within 10 days of hospital discharge gets more of them to show up, according to a new study.

Researchers found the earlier scheduling led to an 18 percent increase in attendance at that first cardiac rehab orientation session, compared to appointments that were scheduled a month or more after discharge.

"This is really a substantial effect size," said Dr. Quinn Pack, the study's lead author. "This is not a hard thing to do. You just have to give people an appointment before they leave the hospital."

For people who have had heart attacks, stents implanted or bypass surgery, cardiac rehab is intended to get them exercising again while learning how to live a healthy lifestyle.

"Cardiac rehabilitation has been well established for 30 years. The biggest problem with it is that people don't go," said Pack, from the Mayo Clinic in Rochester, Minnesota.

He and his colleagues write in the journal Circulation that it's recommended for heart patients to be enrolled in cardiac rehab within one to four weeks of leaving the hospital.

But barely 30 percent of heart attack survivors ever participate in cardiac rehab, and those who do tend to start it 35 days after leaving the hospital, on average, the authors note.

"I think what actually happens is people go home and they're scared to exercise and (they) go back to their dietary habits… and you are not able to capitalize on that habit change initiative," Pack said.

Among the hurdles found in previous studies are delays in being able to get an appointment or in getting insurance preapproval. And every day missed has been linked to a one percent decrease in participation.

For the new study, the researchers randomized 148 heart patients from the Henry Ford Hospital in Detroit into two groups.

One group received appointments an average of 8.5 days after leaving the hospital and the other got appointments after an average of 42 days.

Of the 74 people who got the earlier appointments, 57, or 77 percent, actually showed up to the orientation. That's compared to 44 of the 74 patients, or 59 percent, who got their appointment after the standard time.

There were no other significant differences between the groups, including how many exercise sessions patients ultimately attended, how much their exercise capacity increased or how many completed the rehab program.

Dr. Frank Richeson, director of the cardiac rehabilitation program at the University of Rochester Medical Center in New York, said he's not surprised by the finding that more people attended the orientation when it was scheduled soon after discharge.

"I was surprised that we didn't know that already. Recruitment early when the iron is hot makes a lot of sense intuitively," said Richeson, who was not involved in the new research.

Pack said it should be easy to schedule appointments earlier, because the system is already in place.

"I really think it can make a big difference," he said.

But Pack admits scheduling is not the only obstacle that stands between an individual and cardiac rehabilitation.

He told Reuters Health that insurance preauthorization is also a problem, because that takes time.

"That is an obstacle that we really have to remove. We have to take out the paperwork, the middleman and just get people moving," said Pack.

For this study, the orientation session was free and insurance wasn't an issue.

"I hope insurance systems will look at this and say preauthorization is an obstacle," said Pack.

SOURCE: http://bit.ly/12GxAME Circulation, online December 18, 2012.

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