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January 1, 2012Journal of Cardiopulmonary Rehabilitation and PreventionOpen Access

Systematic inpatient referral strategies significantly increased overall cardiac rehabilitation referral to 77.2% compared to 48.4% with non-systematic referral, and improved enrollment among socioeconomically disadvantaged patients.

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Why the study?

Does systematic inpatient cardiac rehabilitation referral improve equitable access and utilization in coronary artery disease inpatients?

Population

2,635 coronary artery disease inpatients from 11 Ontario hospitals

Comparison

Systematic inpatient cardiac rehabilitation… vs Nonsystematic inpatient cardiac rehabilitation…

Design

Cohort

Follow-up

1 year

Key result

Systematic inpatient referral strategies significantly increased overall cardiac rehabilitation referral to 77.2% compared to 48.4% with non-systematic referral, and improved enrollment among socioeconomically disadvantaged patients.

Authors

SGSherry L. GracePreventive CardiologyYLYvonne LeungUniversity Health NetworkRRRobert ReidUniversity of British Columbia

Discussion

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Member takes

Overview

May boost equitable CR access in disadvantaged CAD patients; hypothesis-generating for RCTs before practice change.

Study Design

Type

Observational (n=2,635)

Multicenter

Yes

Structured PICO

Does systematic inpatient cardiac rehabilitation referral improve equitable access and utilization in coronary artery disease inpatients?

P
Population
2,635 coronary artery disease inpatients from 11 Canadian hospitals were followed for one year to assess the impact of systematic versus non-systematic cardiac rehabilitation referral strategies.
E
Exposure
Systematic inpatient cardiac rehabilitation referral
C
Comparator
Nonsystematic inpatient cardiac rehabilitation referral
O
Outcome
Cardiac rehabilitation utilization (referral and enrollment) at 1 year

Main Result

Absolute Event Rate: 77.2% vs 48.4%

p-value: p=<0.0001

Systematic inpatient cardiac rehabilitation referral improves equitable access and utilization, particularly among socioeconomically disadvantaged patients and those with higher clinical risk.

Limitations

  • Quasi-experimental design without randomization
  • Significant baseline differences in patient characteristics by referral strategy
  • Reliance on unverified self-reported cardiac rehabilitation utilization
  • Potential for inflated error rates due to multiple comparisons
  • Potential Hawthorne effect

Cite This Study

Grace et al. (2012) conducted an observational in Coronary artery disease (n=2,635). Systematic inpatient cardiac rehabilitation referral vs. Non-systematic referral was evaluated on Overall cardiac rehabilitation referral (p=<0.0001). Systematic inpatient referral strategies significantly increased overall cardiac rehabilitation referral to 77.2% compared to 48.4% with non-systematic referral, and improved enrollment among socioeconomically disadvantaged patients.

synapsesocial.com/papers/6a22a9d878907ffe38d2a985https://doi.org/10.1097/hcr.0b013e31823be13b
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Systematizing Inpatient Referral to Cardiac Rehabilitation 20102011 · 27 citations
  2. 2Effect of referral strategies on access to cardiac rehabilitation among women2013 · 38 citations
  3. 3Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned2021 · 17 citations
  4. 4Clinical and sociodemographic correlates of referral for cardiac rehabilitation following cardiac revascularization in Ontario2013 · 20 citations
  5. 5Cardiac Rehabilitation2013 · 13 citations