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Ann Transl Med. 2019 Sep;7(17):415. doi: 10.21037/atm.2019.08.09.

Action plan for improving cardiac rehabilitation-related outcomes in a university hospital based on a review of previous interventions.

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Department of Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Methodist University Hospital, Memphis, TN, USA.
Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.


Although referral to cardiac rehabilitation (CR) is considered the standard of care and demonstrably reduces both mortality rates and hospital admissions after cardiac events, rates of referral continue to be suboptimal. In fact, national reports reveal rates ranging from approximately 60% to 85% depending on the type of cardiac event. At an urban teaching hospital in Tennessee, efforts to increase referral rates were launched during the first quarter of 2018 as part of the Define, Measure, Analyze, Improve, Control (DMAIC) Project: Acute Myocardial Infarction (AMI) Transition of Care. The goal of this Action Plan is to review the interventions taken and the outcomes data from this project in order to propose future deliverables that can address areas of improvement within the DMAIC project. A list of the DMAIC project's interventions, which were varied and multidisciplinary, were obtained from the university hospital as well as the project's data. Data from the National Cardiovascular Data Registry (NCDR)-ACTION Registry show that referral rates at this hospital have been on the rise since the initiation of the DMAIC project. Peak referral rates in the year before the interventions were implemented were approximately 39%; whereas, the peak referral rate in the year these interventions were launched rose to 86.4%. While the interventions of the DMAIC project are hypothesized to have contributed to this increase in referral rates, based on their collaborative nature and the types of referral strategies employed, there are still opportunities for improvement and growth. Thus, this Action Plan proposes future projects to increase inclusivity of CR referral pathways, improve physician education, and establish support for outpatient CR programs.


Cardiac rehabilitation (CR); consultation; myocardial infarction; quality improvement; referral

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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