Heather Christensen Kinesiology Major California State University – Monterey Bay

1. Broken Hearts Need Work Too: Increasing Participation in Cardiac Rehabilitation Post Cardiac Event Heather Christensen Kinesiology Major California State University – Monterey Bay Today’s Healthcare Professionals

2. American Detriment • 1 in 3 Americans have cardiovascular disease (CVD) • Billions of dollars in healthcare costs • Cardiac rehabilitation (cardiac rehab) is cheap • Cardiac rehab works

4. Hurdles to Heart Health • Lack of referrals • Under referred populations • Physician support = Patient participation • Patient Barriers • Approximately 40% attend cardiac rehab (Farley et al., 2003, p. 208) • Patients feel they can ‘deal with it on their own’

5. Factors Associated with Limited Referral and Enrollment in Cardiac Rehabilitation/Secondary Prevention Programs (CR/SPP) • Patient Oriented Factors • Female sex • Older age • Race/ethnic minority group • Low socioeconomic status • Low educational attainment • Low self-efficacy • Low health literacy • Lack of perceived need for CR/SPP • Work related factors (job flexibility, loss of salary, self employment, and lack of healthcare/disability benefits) • Limited social support • Home responsibilities • Medical Factors • Multiple comorbidities including depression and musculoskeletal conditions • Healthcare System Factors • Lack of referral • Lack facilitation of enrollment after referral • Strength of the endorsement of CR/SPP by the patients physician • Program availability and characteristics • Lack of program that serves specific geographic areas, including rural areas and low-income communities • Distance of CR/SPP for patient’s home • Hours of operation • Parking and public transportation access Table adapted from: Balady, G., Ades, P., Bittner, V., Franklin, B., Gordon, N., Thomas, R.,…Yancy, C., (2011). Referral enrollment and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A presidential advisory from the American Heart Association. Circulation. 124. 2952. doi: 10.1161/CIR.0b013e31823b21e2

6. Eligible Patients

7. Non Referred Eligible Patients

8. Non Referred and Non Attending Eligible Patients

9. 2 in 10 Eligible Patients Participating

10. Beneficial Outcomes of Proper Cardiac Care • Physical impairments/ Morbidity/ Cardiac event risks • Focus on exercise • Cardiac rehab better than drugs (Farley et al. 2003, p. 205) • BENEFITS OF EXERCISE OUTWEIGHT RISKS!!!

11. Beneficial Outcomes of Proper Cardiac Care • Quality of Life (QOL) • Cardiac rehab goals: • Increase “functional capacity” • Older adults “reduce frailty” (Dorosz, 2009, p. 726) • Reemployment • 35% do not return to work • Program design could increase reemployment • Decrease burden on society

12. Promoting the Means to a Better Life • Systematic Referral plus Liaison • Increase referral of females, minorities, and low socioeconomic populations • Referral + liaison= 66% increase in enrollment • Health team support and enthusiasm • Options: Home based vs. Center based • Home based program effective and safe

13. We Can Increase Utilization of Cardiac Rehab by: • Promoting the use of systematic referral • Advocating cardiac rehab to heart patients • Understanding options

14. Thank You!! Questions/Comments

15. References Balady, G., Ades, P., Bittner, V., Franklin, B., Gordon, N., Thomas, R., Tomaselli, G., & Yancy, C. (2011). Referral, enrollment and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A Presidential advisory from the American Heart Association. Circulation, 124, 2951-2960. doi:10.1161/CIR.0b013e31823b21e2 Dorosz, J. (2009). Updates in cardiac rehabilitation. Physical Medicine and Rehabilitation Clinics of North America. 20. 719-736. doi: 10.1016/j.pmr.2009.06.006 Farley, R., Wade, T., & Birchmore, L. (2003). Factors influencing attendance at cardiac rehabilitation among coronary heart disease patients. European Journal of Cardiovascular Nursing, 2, 205-212. doi:10.1016/S1474-5151(03)00060-4