Does not apply to this measure

This measure is used to assess the percentage of eligible inpatients with a qualifying event/diagnosis who have been referred to an outpatient cardiac rehabilitation program prior to hospital discharge or have a documented medical or patient-centered reason why such a referral was not made.

There has been growing scientific evidence over the past 3 decades on the benefits of cardiac rehabilitation (CR) services for persons with cardiovascular disease (CVD). Evidence suggests that the benefits of CR services are as significant in recent years as they were in the prethrombolytic era. Because of this mounting evidence, a number of healthcare organizations have endorsed the use of CR services in persons with CVD by including provisions for CR in their practice guidelines and practice management position papers.

Despite both the known benefits of CR and the widespread endorsement of its use, CR is vastly underutilized, with less than 30% of eligible patients participating in a CR program after a CVD event. Reasons for this gap in CR participation are numerous, but the most critical and potentially most correctable reasons revolve around obstacles in the initial referral of patients to CR programs. These obstacles can be reduced through the systematic adoption of standing orders and other similar tools for CR referral for appropriate hospitalized patients. Furthermore, physician accountability associated with the use of these performance measures may lead to new and novel approaches to improve both referral rates and the outcome of patients with CVD.

A key component to outpatient (CR) program utilization is the appropriate and timely referral of patients. Generally, the most important time for this referral to take place is while the patient is hospitalized for a qualifying event/ diagnosis (myocardial infarction [MI], chronic stable angina [CSA], coronary artery bypass graft [CABG] surgery, percutaneous coronary intervention [PCI], cardiac valve surgery, or cardiac transplantation).

This performance measure has been developed to help healthcare systems implement effective steps in their systems of care that will optimize the appropriate referral of a patient to an outpatient CR program. This measure is designed to serve as a stand-alone measure or, preferably, to be included within other performance measurement sets that involve disease states or other conditions for which CR services have been found to be appropriate and beneficial (e.g., following MI, CABG surgery).

Effective referral of appropriate inpatients to an outpatient CR program is the responsibility of the healthcare team within a healthcare system that is primarily responsible for providing cardiovascular care to the patient during the hospitalization.

Acute myocardial infarction (AMI); chronic stable angina (CSA); coronary artery bypass graft (CABG) surgery; percutaneous coronary intervention (PCI); cardiac valve surgery; cardiac transplantation; outpatient cardiac rehabilitation; referral

Number of hospitalized patients in the reporting period hospitalized with a qualifying event/diagnosis who do not meet any of the specified exclusion criteria (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Number of eligible patients with a qualifying event/diagnosis who have been referred to an outpatient cardiac rehabilitation (CR) program prior to hospital discharge or have a documented medical or patient-centered reason why such a referral was not made (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

Administrative data
Medical record

Performance measure A-1: cardiac rehabilitation patient referral from an inpatient setting.

American Association of Cardiovascular and Pulmonary Rehabilitation/American College of Cardiology/American Heart Association

The Writing Committee had one face-to-face meeting at the outset of the writing project. Funding travel to the meeting was covered by the respective organizations (American Association of Cardiovascular and Pulmonary Rehabilitation [AACVPR], American College of Cardiology [ACC], and American Heart Association [AHA]). Conference calls were paid for by AACVPR. Other than in these cases, there were no other funding sources or reimbursements provided.

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Representatives: Randal J. Thomas, MD, MS (Physician, Preventive Cardiologist, Mayo Clinic, Rochester, MN); Marjorie King, MD (Physician, Cardiologist, Helen Hayes Hospital, West Haverstraw, NY); Karen Lui, RN, C, MS (Nurse, GRQ Consulting Firm, Washington, D.C.); Neil Oldridge, PhD (Exercise Science/Physiology, University of Wisconsin-Milwaukee, Milwaukee, WI).

American College of Cardiology (ACC) Representatives: Ileana Piña, MD (Physician, Cardiologist, Case Western Reserve University, Cleveland, OH).

American Heart Association (AHA) Representatives: John Spertus, MD, MPH (Physician, Cardiologist, Mid America Heart Institute/University of Missouri-Kansas City, MO).

Author Relationships with Industry -- American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)/American College of Cardiology (ACC)/American Heart Association (AHA) Cardiac Rehabilitation/Secondary Prevention Performance Measures

Measure was not adapted from another source.

2007 Sep

This is the current release of the measure.

This NQMC summary was completed by ECRI Institute on July 18, 2008. The information was verified by the measure developer on September 3, 2008.

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

AACVPR provides approval for hosting and downloading the document: AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services.

American College of Cardiology Foundation/American Heart Association

• Permission does not include the ACC and AHA logos. This material cannot be used for resale, advertising, or promotional purposes.
• Use of this material does not convey (or appear to convey) that the product or practice is produced or owned by the American College of Cardiology Foundation (ACCF) and/or has the endorsement of the ACCF/AHA.
• Full acknowledgement of the original source must be accompanied by a copyright statement that includes all information encompassed in the following example: Reprinted [Modified] with permission from Thomas RJ, King M, Lui K, et al. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol 2007;50:1400-33.