Philadelphia researchers established a system of alerts based on electronic medical records to identify patients who qualify for cardiac rehabilitation at the Hospital of the University of Pennsylvania. Simply changing cardiac referral processes to opt-out rather than opt-in significantly increased referral rates, according to the study presented at the American College of Cardiology's NCDR Annual Conference (NCDR.18) in Orlando.

Cardiac rehab is a medically supervised program designed to help improve cardiovascular health in patients who have experienced a heart attack, heart failure, angioplasty or heart surgery. It has been shown to reduce the rates of cardiovascular deaths and readmissions and to improve quality of life in patients with heart disease.

Cardiac rehab consists of exercise counseling and training; education for heart-healthy living–including smoking cessation tools; and counseling to reduce stress. The study included patients who had a heart attack or stent placement, also called percutaneous coronary intervention (PCI).

"Cardiac rehab gives patients an opportunity to get back to or begin exercising safely under the guidance of a specialist and helps them understand medications they've been placed on," said lead researcher Elizabeth Jolly, interventional cardiology transitions coordinator at the Hospital of the University of Pennsylvania in Philadelphia.

Jolly's team–in collaboration with the Penn Medicine Center for Healthcare Innovation–designed intelligent alerts from patients' electronic medical records to alert the Coronary Artery Disease Transitions Coordinator and Case Management Team every morning about which patients potentially could qualify for cardiac rehab.

If a patient wanted to enroll in a cardiac rehab program, the staff helped them choose a convenient facility in their ZIP code region. The staff member then forwarded the referral to the cardiac rehab facility. The transition coordinator contacted patients within a week of discharge to ask about their plans and facilitated their enrollment into cardiac rehab.

The cardiac team was educated by Jolly's team on the benefits of cardiac rehab. Educational materials were provided to the discharging nursing units to distribute to all patients after a heart attack or PCI. Staff discussed the benefits of cardiac rehab with eligible patients prior to discharge.

In the 21 months before implementing the program, the hospital's average cardiac rehab referral rate was 12%. After the program was implemented, the cardiac referral rate increased to 75% in the following three quarters. In two other hospitals, awareness of the importance of cardiac rehab was raised. In those hospitals, the referral rate rose from 4.2 to 24.8% at one hospital and from 4 to 25.4% at the second hospital.

"At a big institution like ours, we have so many patients that it's not always evident who qualifies for cardiac rehab. Now we know in real time. We started bringing cardiac rehab into our conversations with patients and adding it to discharge documentation and conversations following discharge as well. Now this is part of our daily workflow."