Abstract 12723: Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, and Valve Surgery: Data From the Clinical Outcomes Assessment Program

Abstract

Introduction: Despite guideline recommendations that all patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG), or valve surgery be referred to cardiac rehabilitation, cardiac rehabilitation is underused. The objective of this study was to identify predictors of cardiac rehabilitation referral after PCI, CABG, and valve surgery. Methods: We analyzed data from the Clinical Outcomes Assessment Program (COAP), a registry of all non-federal hospitals performing PCI and cardiac surgery in Washington State. We included eligible PCI, CABG, and valve surgery patients from 2010 to 2015 who were discharged alive. We analyzed PCI and cardiac surgery separately by performing multivariate hierarchical logistic regression for the outcome of cardiac rehabilitation referral at discharge, clustered by hospital. Candidate predictors included age, gender, race/ethnicity, and comorbidities. Results: Cardiac rehabilitation referral was reported in 47% (32,049/67,556) of eligible PCI patients from 36 hospitals and 91% (19,320/21,329) of eligible cardiac surgery patients from 20 hospitals. The hospital in which the procedure was performed was a stronger multivariate predictor of referral than any individual patient characteristic for both PCI (hospital referral range 2% to 97%; median odds ratio 6.29; 95% confidence interval 4.27, 10.24) and cardiac surgery (hospital referral range 49% to 100%; median odds ratio 5.92; 95% confidence interval 3.48, 12.60)(Figure). Conclusions: Cardiac rehabilitation referral at discharge was less prevalent after PCI than cardiac surgery. The strongest predictor of cardiac rehabilitation referral was hospital in which the procedure was performed. Efforts to improve cardiac rehabilitation referral should focus on increasing referral after PCI, especially in hospitals with low referral.