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Patients in the United States diagnosed with Cardiovascular Disease (CVD)  in need of secondary prevention measures including cardiac rehab (CR)

Annual # of CR-qualifying events:

acute MI (735,000)

CABG surgery (395,000)

PCI (454,000),

new cases HFrEF discharged from the hospital (504,000)

(Ades et al, 2017).

Cost
Cardiovascular disease costs  over $200 billion per year in U.S. alone  (Widmer, 2017).

2012 acute MI hospitalization w/ LOS average 4.6 days costs greater than $72, 000 . Non-monetary cost-->in hospital death rate of 5.16%.  (Thomas et al., 2018).

2012 greater than 500,000 patients with heart diseases treated in hospital with mean LOS 3.7 days and associated charges approaching $69,000 (Thomas et al., 2018)

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No universal health-care system exists. Multiple subsystems co-exist
1)Managed Care
2)Military
3)Government programs: Medicare, Medicaid, State CHIP

No central controlling agency

Variety of payment, insurance, and delivery systems

Financed publicly (45%  expenditures) and privately (55% expenditures)

High cost, unequal access, average outcomes

Integrated Delivery Systems (IDS)
Definition: Network of organizations that provides or arranges to provide a continuum of services to a defined population and that is willing to be held clinically and fiscally responsible for the outcomes and health status of the population
Participants: physicians, hospitals, insurers
Objective: have one organization deliver range of services

(Shi & Singh, 2017)

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Heart disease the is leading cause of death in the United States (CDC)

Approximately 50% of the 1 million Americans that suffer (ACS) will have a repeat event (Widmer, 2017).

90% of CVD M&M is attributed to preventable and modifiable risk factors  (Widmer, 2017).

Cardiac rehabilitation (CR)  is a class 1A recommendation and 1of 9  performance measures for secondary prevention established by AHA/ACC after MI , PCI, CABG, stable angina, or symptomatic  PAD. (Thomas et al, 2019

CR participation rates  nationally range  from 19-34% (Ades et al, 2017).

Challenges/Barriers to CR participation

Patients need to return to work, the cost burden, inconvenient hours, transportation issues,  and cultural barriers (Ades et al, 2018)

Geographic location, age, physical limitations, socioeconomic status (Widmer, 2017).

Inequities exist: CR participation particularly low in medicare beneficiaries, veterans, women, older adults,  underserved minority groups, lower socioeconomic classes, and uninsured/underinsured (Thomas et al, 2019).

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CR is an evidence based intervention that uses patient education, health behavior modification and exercise training to improve secondary prevention outcomes  (Thomas et al, 2019).

CR decreases recurrent MI and mortality rates, improves patients QOL, and ability to return to work more quickly. Participation associated with 20-30% reduction in hospital readmission during the year after CV event (Thomas et al., 2018)

Plan : Implement strategies known to effectively increase referral and enrollment rates in Cardiac Rehab

Do:
1)Start a home-based cardiac rehabilitation option (longer timeline given need for program development and training)
2) implement automatic inpatient CR referral system ( initiate ASAP )
3)secure  early CR appointment prior to patient discharge  ( initiate ASAP )

Study:
Did referral to CR increase with these systems in place ?
Did enrollment and participation rates in CR increase?
Did health outcomes improve as evidenced by decreased hospital readmission and decreased morbidity and mortality?

Act:
Expand initiatives to all center-based cardiac rehabs in WNY if referral and participation rates increase. Share data nationally and with payers to start discussion about  benefits and coverage for home-based CR delivery model

(Ades et al, 2017).

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Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative

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The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts' focus on achieving more than 70% performance in the "ABCS" of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022.

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Visit links below for more information  

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Visit links below for more information  

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Million Hearts cardiac rehab collaborative

Home-Based Cardiac Rehab AHA/ACC/AACVPR statement

ACC/AHA performance and quality measures for CR

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Centers for Disease Control and Prevention

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During the COVID-19 pandemic, cardiovascular health remains a top public health priority.

Use these lifesaving messages to encourage individuals to continue seeking cardiovascular care at this time.

Million Hearts® 2022

Million Hearts ® 2022 is a national initiative to prevent 1 million heart attacks and strokes within 5 years. It focuses on implementing a small set of evidence-based priorities and targets that can improve cardiovascular health for all.

Priority Topics

Clinical Tools

Million Hearts ® Strategies in Action

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Learn how this federally funded health center addressed cultural and social barriers to help patients better manage their hypertension.
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Using Home Blood Pressure Monitoring for Hypertension Control Success

Learn how this cardiology practice used at-home blood pressure monitoring and team-based care to achieve hypertension control.
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Page last reviewed:

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centers for disease control and prevention

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division for heart disease and stroke prevention

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During the COVID-19 pandemic, cardiovascular health remains a top public health priority. Use these lifesaving messages to encourage individuals to continue seeking cardiovascular care at this time. Million Hearts ® 2022 is a national initiative to prevent 1 million heart attacks and strokes within 5 years.