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Mayo Clin Proc. 2017 Feb;92(2):234-242. doi: 10.1016/j.mayocp.2016.10.014. Epub 2016 Nov 15.

Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative.

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Cardiac Rehabilitation and Prevention Program, University of Vermont College of Medicine, Burlington, VT. Electronic address:
Preventive Cardiology, Henry Ford Hospital, Detroit, MI.
Million Hearts, Centers for Disease Control and Prevention, Atlanta, GA.
Clinical Exercise Physiology Program, Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC.
GRQ, LLC, Vienna, VA.
Cardiac and Pulmonary Rehabilitation, Sutter Roseville Medical Center, Roseville, CA.
Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
Cardiac Rehabilitation Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.


The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts' focus on achieving more than 70% performance in the "ABCS" of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022. Cardiac rehabilitation is a class Ia recommendation of the American Heart Association and the American College of Cardiology after myocardial infarction or coronary revascularization, promotes the ABCS along with lifestyle counseling and exercise, and is associated with decreased total mortality, cardiac mortality, and rehospitalizations. However, current participation rates for CR in the United States generally range from only 20% to 30%. This road map focuses on interventions, such as electronic medical record-based prompts and staffing liaisons that increase referrals of appropriate patients to CR, increase enrollment of appropriate individuals into CR, and increase adherence to longer-term CR. We also calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States.

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