Improving cardiac rehabilitation attendance and completion through quality improvement activities and a motivational program.

PURPOSE: Recent studies have demonstrated that patients who attend more cardiac rehabilitation (CR) sessions have lower subsequent mortality rates than those who attend fewer sessions. METHODS: We analyzed the impact of several phased-in policy and process changes implemented to increase patient participation in CR. In March 2010, our CR program changed from a policy of individualizing the recommended number of CR sessions per patient to a policy that recommended all 36 CR sessions. In October 2010, we introduced a 7-minute video describing the benefits of CR. In August 2011, we introduced a motivational program that rewarded patients after every sixth CR session. The number of CR sessions attended was determined through review of billing records. Enrollment and completion were defined as attending ≥1 session and ≥30 sessions, respectively. RESULTS: We identified 1103 patients sequentially enrolled in CR between May 2009 and January 2012. Overall, the median number of sessions per patient improved from 12 to 20 (P < .001). Completion rate improved from 14% to 39% (P < .001). The motivational program increased attendance by a median of 3 sessions per patient (P = .04), but this effect was limited to local CR participants. Financial analysis suggested that for every $100 spent on motivational rewards, patients attended an additional 6.6 (95% CI, -1 to 14) sessions of CR. CONCLUSIONS: Quality improvement activities significantly increased CR participation. Wide implementation of such programs may favorably impact patient participation in CR and potentially decrease the rate of subsequent cardiac events.

Screening for obstructive sleep apnea in early outpatient cardiac rehabilitation: feasibility and results.

BACKGROUND: Obstructive sleep apnea (OSA) has been recognized as a risk factor for cardiovascular disease and mortality. The aim of this study was to determine the feasibility and efficacy of implementing a screening program for OSA in early outpatient cardiac rehabilitation (CR) and to estimate the risk for OSA in this population. METHODS: From 535 consecutive patients enrolled in early outpatient CR we screened 383 (72%) patients and classified them as low- vs. high-risk for OSA using the Berlin questionnaire. Those considered at high-risk for OSA were referred for further evaluation. We assessed the yield and feasibility of the screening program, patient compliance with referral, and the percentage of patients diagnosed with OSA after polysomnography. RESULTS: Mean age was 63 ± 12 years, 70% were men, 20% had diabetes, 65% had hypertension, and 58% had experienced a recent myocardial infarction. Two hundred and one patients (52%) had a high risk for OSA based on the questionnaire. Of the 169 who completed the CR program, only 111 (78%) were referred for further evaluation (Fig. 1). Of the 74 patients who completed their OSA work-up, 39 were found to have OSA with an apnea-hypopnea index of ≥ 5 events/h. CONCLUSIONS: Implementation of a simple screening program for OSA in early outpatient CR is feasible with minimal incremental resources. A significant percentage of patients at high-risk decline further evaluation, suggesting that their perceived risk for OSA and its consequences may be low.