What question did this study set out to answer?

To assess the effectiveness of referral practices for cardiac rehabilitation following percutaneous coronary interventions.

January 10, 2026Cureus0 citationsOpen Access

Quality Improvement Study: Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention

NFNatalia FongratMary Washington Hospital GGGeronimo GuzmanSaba University CDCourtney D. DeihrMary Washington Hospital

Key Points

To assess the effectiveness of referral practices for cardiac rehabilitation following percutaneous coronary interventions.
Conducted a quality improvement study focusing on referral processes for cardiac rehabilitation.

Structured PICO

What are the referral and enrollment rates for cardiac rehabilitation after PCI, and what barriers prevent patient participation?

Population

194 adult patients (mean age 68±11 years, 34% female) who were at least three months post-percutaneous coronary intervention (PCI) and discharged alive from a single community hospital in the United States.

Intervention

Referral to cardiac rehabilitation (CR) placed either at hospital discharge or at the first outpatient follow-up clinic visit.

Comparator

No referral to cardiac rehabilitation, or comparison between referral timing (discharge vs. first follow-up visit).

Outcome

Referral and enrollment rates in cardiac rehabilitation following PCI, and identification of patient-reported and system-level barriers to participation.

Referral and enrollment in cardiac rehabilitation after PCI remain markedly low, primarily driven by system-level barriers and patient lack of awareness, highlighting the need for improved patient education and referral processes.

Abstract

Background Cardiac rehabilitation (CR) is a key post-percutaneous coronary intervention (PCI) quality metric and is known to improve cardiovascular outcomes. Although referral rates after PCI have been described, far less is known about what occurs after a referral order is placed, specifically whether patients are successfully contacted, whether they enroll, and the barriers they encounter. This quality improvement (QI) project aimed to determine referral and enrollment rates following PCI, compare referral timing at discharge versus the first follow-up visit, and identify patient-reported and system-level barriers contributing to low CR participation. Methods We performed a retrospective chart review of 200 consecutive patients who were at least three months post-percutaneous coronary intervention. All patients not enrolled in the CR program at our center were prospectively contacted at home to confirm if they were referred to, and whether they were doing CR. If patients were not enrolled, reasons were explored. Results A total of 194 patients were discharged. The mean age was 68±11 years, and 34% (n=65) were female. The overall referral rate was 55% (n=107), including 21.6% (n=42) at hospital discharge and 33.5% (n=65) at the first outpatient clinic visit. After at least three months post-PCI, only 35 patients (18% of the entire group and 33% of those referred) were enrolled in CR. Of those with a referral order placed at discharge, only 10 (24%) were doing CR. The most common reason for non-enrollment in cardiac rehabilitation was lack of awareness of the need to enroll, reported by 58% (n=92) of respondents. In a multivariate analysis, PCI in an urgent setting and prior PCI were the only independent predictors of non-referral. Not private insurance and diabetes were independent predictors of lack of CR participation. Conclusions Referral to, and especially enrollment in, the CR programs post-PCI remained markedly low. Enrollment tended to be lower when referrals were placed at discharge, highlighting limitations of current quality metrics that focus solely on referral placement. Improving patient and physician education and strengthening system-level processes may help support higher enrollment and more effective use of CR.

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