INCREASING CARDIAC REHABILITATION ENROLLMENT THROUGH A VIRTUAL PROGRAM: A MULTIDISCIPLINARY QUALITY IMPROVEMENT INITIATIVE

Abstract

Therapeutic Area: Rehabilitation Background: Cardiac rehabilitation (CR) is a Class 1A recommendation by the American Heart Association as a secondary prevention measure in patients with cardiovascular disease. Despite the known benefits of CR, only 10-30% of eligible patients participate nationwide. Methods: We performed multiple Plan-Do-Study-Act (PDSA) cycles to increase participation in CR from January 2022 to May 2023 in our post-percutaneous coronary intervention (PCI) patients. Initially, we increased outpatient CR referrals through modification of the post-PCI order set. However, there was a limitation in staff and equipment availability leading to lack of access. In our next PDSA cycle, we partnered with Recora, a virtual rehab program to facilitate CR at patients’ homes. Through an interdisciplinary approach with case management, we screened patients that were either a better fit for home-based or center-based CR depending on their preference and social situation (Figure 1). The primary outcome was the percentage of patients who completed CR. Secondary outcomes included the number of patients who attended the initial session, the number who enrolled in CR, and demographics. Results: The completion rate of CR was 65% of 332 patients enrolled in Recora for eight months, statistically significantly higher than center-based CR at 47% of 195 patients (χ2=16.2, p <0.0001) (Figure 2). Using Recora, there were statistically significantly 17% more women participants in comparison to center-based CR (χ2=6.698, p <0.0001). The percentage of Black, Asians and Hispanics was comparable in both groups. Conclusions: Virtual-based CR is an effective alternative to facility-based CR in centers reaching their limit due to staff limitations as well as for patient convenience. Overall, it allows for greater number of patients to participate in addition to center-based CR. One of the limitations of the study is expiration of the COVID-19 public health emergency, which led to the early completion for some participants.