In a recent article published in the Journal of the American College of Cardiology, the American College of Cardiology (ACC) and the American Heart Association (AHA) provided updated recommendations regarding quality measures that may improve the quality of current cardiac rehabilitation (CR) strategies in the United States.
These new measures included evidence-based recommendations on inpatient and outpatient referrals for exercise training in patients with heart failure with reduced ejection fraction, suggestions for improving CR time to enrollment as well as CR adherence, and highlights on the importance of CR communication among healthcare professionals.
According to the committee members, the definition of a CR program is “a systematic, medically supervised program that helps patients recuperate from their cardiac event; adopt and adhere to healthy lifestyle habits; address comorbid conditions (eg, depression, diabetes mellitus, sleep apnea); monitor for safety issues, including new or recurrent signs or symptoms; and, adhere to evidence-based medical therapies.” For this update, the ACC/AHA used this definition to systematically review evidence-based guidelines published between 2008 and 2016 and to provide recommendations for improving the quality of CR programs for inpatients and outpatients.
New Class 1 recommendations involve the referral of inpatients and outpatients to CR programs that include exercise training, citing Class 2a evidence claiming that exercise training may help improve functional capacity, quality of life, exercise duration, and mortality.
In addition, the committee suggests the use of claims-based data or registry-electronic health record data for facilitating CR enrollment and subsequent participation. Earlier enrollment in a CR program is also recommended, as the committee suggested that there is an approximately 1% decrease in CR participation each day after hospital discharge.
The committee also emphasized the importance of educating patients on CR adherence for improving outcomes. Specifically, the committee reported that attending ≥36 sessions is associated with reduced 4-year risk for mortality and myocardial infarction compared with patients attending fewer CR sessions. Improving care coordination and communication among healthcare professionals is also cited as an important quality measure for patients receiving CR.
The investigators also highlighted the need for further research to improve CR performance and quality measures, including the comparative assessment of the “effectiveness of center-based vs novel CR delivery models in implementing CR performance and quality measures to improve CR participation and adherence rates.”
Thomas RJ, Balady G, Banka G, et al. 2018 ACC/AHA clinical performance and quality measures for cardiac rehabilitation: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures [published online March 29, 2018]. J Am Coll Cardiol. doi:10.1016/j.jacc.2018.01.004