AHRQ Project Designed to Increase Use of Cardiac Rehab After Coronary Events

Days ago, the Agency for Healthcare Research and Quality (AHRQ) announced a $6 million, 3-year project designed to save lives by increasing the patient’s participation in their cardiac rehabilitation after cardiovascular events such as heart attacks, heart failure, angioplasty, or heart surgery.

Cardiac rehabilitation programs designed to help patients return to an active lifestyle through medically supervised education, exercise training and psychological support.  But, only 20 percent of the nearly one million Americans who experience a cardiovascular event each year participate in cardiac rehabilitation despite the evidence that doing so saves lives and reduces healthcare costs.  Older and sicker patients, women, minorities and patients with lower socioeconomic status or education may be even less likely to participate, notes AHRQ, whose mission is to enhance the quality, appropriateness, and effectiveness of health care services and access to care.

“For us to achieve patient-centered healthcare for cardiac patients, we must ensure that more of them are enrolled in life-saving cardiac rehabilitation services,” said Gopal Khanna, M.B.A., AHRQ’s director, in an April 16, 2019 statement announcing the new initiative. “This effort will tackle the problem in several ways, including not just on-the-ground training, but also development of an online platform to curate and promote urgently needed resources,” notes Khanna.

Cardiac Rehab Can Reduce Cardiovascular Deaths

AHRQ estimates that increasing participation in cardiac rehabilitation programs from about 20 percent to 70 percent could save nearly 25,000 lives and prevent about 180,000 hospitalizations a year.  Research suggests that cardiac rehabilitation reduces cardiovascular deaths by nearly 30 percent and risk of hospital admissions by 31 percent, says AHRQ.

According to AHRQ, low rates of referrals to cardiac rehabilitation may be attributable to the limited awareness of clinicians of the rehabilitations benefits. Even when referrals are made, patients often don’t enroll or leave rehabilitation prematurely.  Reasons for this include not following up with their primary care clinician, completing work or home responsibilities, and scarcity of rehabilitation programs in rural areas or low-income communities.  In addition, some programs don’t address the needs of women, language barriers or the need for cultural sensitivity, says AHRQ.

Abt Associates, one of the world’s largest for-profit government and business research and consulting firms, received the contract to oversee AHRQ’s new initiative.  The Cambridge, Mass-based company will work to increase participation in cardiac rehabilitation programs by partnering and training at least 100 hospitals and health systems to increase rehabilitation referrals, enrollment and retention.

These efforts will apply strategies in the new Million Hearts®/AACVPR Cardiac Rehabilitation Change Package a quality improvement action guide developed by the Centers for Disease Control and Prevention (CDC) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPRP).

Using this guide developed by CDC and AACVPR, the project will engage receptive hospitals to initially adopt two strategies proven to increase cardiac rehabilitation participation: automated referrals of patients who qualify, and a trained liaison to help make the referrals happen.

Project Hopes to Prevent One Million Heart Attacks and Strokes

“We are thrilled that AHRQ is supporting the implementation of our evidence-based Cardiac Rehabilitation Change Package.  Their leadership to increase participation in cardiac rehabilitation for patients will meaningfully contribute to the national target of achieving 70 percent participation. It will ultimately help reach the Million Hearts®2022 goal of preventing one million heart attacks and strokes and, more broadly, help more Americans live longer and healthier lives,” said Betsy L. Thompson, M.D., M.S.P.H., DrP.H., Director, Division of Heart Disease and Stroke Prevention, CDC.

Hospitals participating in the initiative, as well as others that join a new learning network, will also benefit from a website that will emphasize the negative impacts of cardiac rehabilitation underuse, the value of increased utilization, and the availability of existing resources to promote referrals, enrollment and retention.

AHRQ’s new project, funded by the Patient-Centered Outcomes Research Trust Fund, advances HRQ’s initiatives to enhance heart health. It also will contribute to the national Million Hearts®2022.