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Cardiac Rehabilitation Referral Does Not Boost Enrollment

American Heart Association guidelines lead to higher referral rates, but only about one-third of referred patients enroll

FRIDAY, April 11 (HealthDay News) -- Use of the American Heart Association's Get With The Guidelines-based clinical pathway at one medical center resulted in a significantly higher referral rate to cardiac rehabilitation after acute myocardial infarction than has been previously reported. But only about one in three referred patients enrolled in a rehabilitation program, and minority patients were especially unlikely to enroll, according to a report published in the April 15 issue of the American Journal of Cardiology.

Michael J. Mazzini, M.D., of Boston Medical Center and Boston University School of Medicine, and colleagues conducted an 18-month study of 780 post-acute myocardial infarction patients who were discharged to home, including 714 (92 percent) who were on the Get With The Guidelines pathway.

The researchers report that 392 (55 percent) were referred for cardiac rehabilitation and only 135 patients (19 percent) were enrolled in a cardiac rehabilitation program. They note that referral was strongly associated with pathway use, percutaneous coronary intervention and in-patient physical therapy consultation (odds ratios 2.3, 3.1 and 13.0, respectively). Although ethnicity did not affect referral, the investigators found that it was the only variable associated with lower enrollment, and that Hispanic and black patients were 92 percent and 57 percent less likely to enroll than their white counterparts, respectively.

"Strategies to bridge the gap between referral and enrollment in cardiac rehabilitation should be incorporated into acute myocardial infarction clinical pathways, with special emphasis on increasing enrollment in ethnic minorities," the authors conclude.

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