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Should we give the patient (or the cardiologist) a choice in referring patients to rehabilitation?

Comment by Paul Dendale, on behalf of the EACPR Cardiac Rehabilitation section

Effect of Cardiac Rehabilitation Referral Strategies on Utilization Rates
A Prospective, Controlled Study

Sherry L. Grace, PhD; Kelly L. Russell, MSc; Robert D. Reid, PhD, MBA; Paul Oh, MD, FRCPC; Sonia Anand, MD, PhD, FRCPC; James Rush, PhD; Karen Williamson, PhD; Milan Gupta, MD; David A. Alter, MD, PhD, FRCPC; Donna E. Stewart, MD, FRCPC; for the Cardiac Rehabilitation Care Continuity Through Automatic Referral Evaluation (CRCARE) Investigators

Arch Intern Med. 2011;171(3):235-241


This study compares four different strategies for referral to cardiac rehabilitation as used in different hospitals in Canada. “Usual” referral was defined as asking the cardiologist to refer the patient if he/she considered it suitable.The other strategies were an automatic referral note based on the electronic medical file given to the patient on discharge, a personal discussion with a health professional or rehab team member, or a combination of both strategies.

The main finding of the study was that the combination of a personal information and an automatic referral was 8 times more effective than “usual care” to increase participation in cardiac rehabilitation. For centres that do not have the manpower to have a health professional explain the merits of cardiac rehabilitation to each patient before discharge, an automatic referral note generated by the medical file system can be a good second choice.

The good news from this study was that, once the patient was convinced to come to ambulatory rehabilitation, the participation rate was very high (around 80%). The Canadian centres apparently found a way to increase adherence to rehabilitation to very high levels, but the study unfortunately did not specify how this was done...

Notes to editor

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology