July 12, 2026Journal of the American College of Cardiology168 citations
View Full PaperTemporal Trends and Factors Associated With Cardiac Rehabilitation Referral Among Patients Hospitalized With Heart Failure
Key Result
Only 10.4% of eligible patients hospitalized with heart failure received a cardiac rehabilitation referral at discharge, though referral rates increased significantly over time (ptrend <0.0001).
Key Points
- The aim was to analyze trends and factors associated with cardiac rehabilitation referral at discharge for heart failure patients.
- Data from the Get With the Guidelines-Heart Failure registry was used, focusing on patients hospitalized for heart failure between 2005 and 2014.
- Temporal trends in CR referral rates were assessed, and multivariable analysis identified associated factors.
- The study included 105,619 heart failure patients with both reduced and preserved ejection fraction.
- 10.4% of eligible heart failure patients received cardiac rehabilitation referral at discharge.
- CR referral rates significantly increased over the study period (ptrend <0.0001 for both HFrEF and HFpEF).
- Younger age, fewer comorbid conditions, and undergoing in-hospital procedures were strongly associated with CR referral.
Study Design
Type
Observational (n=105,619)
Multicenter
Yes
PICO
P
Population
105,619 patients hospitalized with decompensated heart failure (48% HFrEF, 52% HFpEF) assessed for cardiac rehabilitation referral at discharge between 2005 and 2014.
E
Exposure / Comparator
Patient and hospital-level characteristics
O
Primary Outcome
Cardiac rehabilitation referral at discharge, p=<0.0001
Main Result
p-value: p=<0.0001
Abstract
BACKGROUND: Current guidelines recommend cardiac rehabilitation (CR) in medically stable outpatients with heart failure (HF); however, temporal trends and factors associated with CR referral among these patients in real-world practice are not entirely known. OBJECTIVES: The purpose of this study was to assess proportional use, temporal trends, and factors associated with CR referral at discharge among patients admitted with decompensated HF. METHODS: Using data from a national Get With the Guidelines-Heart Failure registry, we assessed the temporal trends in CR referral among eligible patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) at discharge after HF hospitalization between 2005 and 2014. On multivariable analysis, we also assessed patient- and hospital-level characteristics that are associated with CR referral. RESULTS: Among 105,619 HF patients (48% with HFrEF, 52% with HFpEF), 10.4% (12.2% with HFrEF, 8.8% with HFpEF) received CR referral at discharge. A significant increase in CR referral rates was observed among both HFpEF and HFrEF patients over the study period (ptrend <0.0001 for HFrEF, HFpEF, and overall). Compared with patients discharged without CR referral, patients referred for CR were younger, predominantly men, and more likely to receive evidence-based HF therapies at discharge. On multivariable analysis, younger age, fewer comorbid conditions, and in-hospital procedures such as coronary artery bypass grafting, percutaneous coronary intervention, and cardiac valve surgery were most strongly associated with CR referral. CONCLUSIONS: Only one-tenth of eligible HF patients received CR referral at discharge after hospitalization for HF. The proportional use of CR referral is increasing over time among both HFrEF and HFpEF patients. Further strategies to improve physician and patient awareness in regard to the benefit of CR should be used to increase CR referral among patients with HF.
Expert Takes1 quote
“Although we expected some under-referral to cardiac rehabilitation in the heart failure population, the results of this study are startling.”
Gregg Fonarow, Cardiovascular medicine chair, UCLA David Geffen School of MedicineUCLAauto_pipelineView source