Abstract 17468: Barriers and Facilitators Associated with Utilization of Cardiac Rehabilitation Programs at VA Facilities

Abstract

Background: Exercise-based cardiac rehabilitation (CR) programs reduce morbidity and mortality in patients with ischemic heart disease (IHD). Referral of patients with IHD to a CR program is a performance measure highlighted in recent guidelines for secondary prevention. Although CR programs are underutilized among Medicare beneficiaries, utilization of CR has not been evaluated in the Veterans Health Administration (VA). We performed a mixed-methods, qualitative study to determine the proportion of VA facilities that offer CR programs and to identify factors associated with referral to these programs.

Methods: In 2011, VA conducted a survey of cardiovascular specialty care services that included the question “Does your facility have a CR program?” We interviewed key informants (physicians, nurses, and physical therapists) at each VA facility that answered affirmatively to this question. We determined the number of patients hospitalized for acute myocardial infarction (MI) and treated for IHD in 2010 based on VA administrative data. Our goals were (1) quantify the burden of IHD in VA, (2) to confirm the existence of unique CR programs, and (3) determine barriers and facilitators associated with referral.

Results: VA treated 25814 patients with IHD and 7959 with acute MI in 2010. Of 149 VA facilities, 39 responded that they had a CR program, and 31 unique programs (21% of VA facilities) were confirmed by interview. The number of new enrollees to the CR program at each facility ranged from 1 to 13 patients per month. The most common facilitator was existence of a hospital policy encouraging referral to CR. The most common barrier was lack of provider knowledge about the benefits of CR (Table).

Conclusions: Significant need for CR programs exists within VA; however, a minority of facilities have CR programs. Factors that may improve utilization are (a) greater availability of programs, (b) changes in hospital policy, and (c) provider education about the benefits of CR.