For American Heart Month, AHRQ Offers New Tools for Expanding Cardiac Rehabilitation

In healthcare, few things are more regrettable than missed opportunities to help patients heal. Unfortunately, these missed opportunities occur far too often due to fragmentation in care.  Challenges in coordinating services across acute and nonacute care settings are common in our Nation, especially for racial and ethnic minority communities, rural residents, and other underserved populations.

This fragmentation seriously affects patients, such as when eligible heart disease patients do not participate in cardiac rehabilitation. Medically supervised cardiac rehabilitation has reduced cardiovascular disease morbidity and mortality by about 20 percent; it also reduces hospital admissions by 28 percent and the risk for long-term readmissions by 25 percent.  About 25,000 American lives could be saved yearly if cardiac rehabilitation participation increased from 20 percent to 70 percent.

Despite cardiac rehab’s potential life-saving benefits, only about a quarter of eligible patients participate. The rate is estimated to be lower among “minority” populations—a particularly urgent concern when considering that the risk of heart failure for Black men and women is 70 percent and 50 percent higher, respectively, than for White men and women.

As we recognize American Heart Month—and once again rank heart disease as America’s leading cause of death—AHRQ is pleased to share newly available online training materials developed through AHRQ’s TAKEheart initiative to improve use of cardiac rehabilitation. These materials offer customizable training slides, implementation guides, and additional resources focused on four areas:  

• Getting started: Lay the foundation for change, including making the case to executive leadership and governance bodies, mapping your hospital's current processes, and collecting baseline data.
• Implementing automatic referrals: Learn how to design, test, implement, and troubleshoot automatic referrals for cardiac rehabilitation in patients’ electronic health records.
• Enhancing care coordination: Establish or enhance your hospital's care coordination system, address the needs and concerns of patients and their family members, and facilitate cardiac rehabilitation enrollment.
• Implementing hybrid cardiac rehabilitation to expand access and capacity: Discover innovative approaches to boost cardiac rehabilitation enrollment and assess whether to implement hybrid cardiac rehabilitation to reach more patients.

These TAKEheart training materials were developed as part of a 4-year collaboration between AHRQ and Million Hearts, an initiative of the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services. The initial cohorts of hospitals recruited to receive the TAKEheart training overrepresented hospitals in rural and high-poverty areas, as well as hospitals that served higher-than-average proportions of African Americans and Native Americans. About 70 percent of 136 participating hospitals reported progress on implementing automatic referrals, and many enhanced care coordination and increased rehab retention efforts.

In addition to supporting activities to increase cardiac rehab rates, AHRQ has made significant investments to equip primary care clinicians with resources to detect heart disease risk factors and warning signs. Diagnosing and treating heart disease in its early stages is crucial to reducing patients’ risks of serious complications and damage to the heart.

AHRQ’s EvidenceNow: Advancing Heart Health project found that small- and medium-sized primary care practices can improve heart health by counseling patients on aspirin use, focusing on blood pressure control, improving cholesterol management, and continuing the push against smoking.

This project developed Tools for Change, a collection of resources to help primary care practices implement the best evidence for reducing cardiac risks and improving care for patients with heart conditions. It includes Integrating Cardiovascular Disease Risk Calculators into Primary Care, a guide to help primary care physicians assess their patients’ risk of a cardiovascular disease event.

In addition, AHRQ’s EvidenceNOW: Building State Capacity initiative aims to advance heart health equity by reducing fragmentation in care by encouraging the alignment of primary care and public health interventions in four States with high levels of preventable cardiovascular events. Through this project, for example, the Tennessee Heart Health Network developed motivational interviewing training to help primary care practices improve the use of patient self-monitoring of blood pressure and encourage greater use of state quit-smoking phone lines and other smoking cessation supports.

Heart disease remains an outsized threat to Americans, claiming about 700,000 lives yearly. During American Heart Month, AHRQ is pleased to join the Nation’s growing efforts to improve the heart health of Americans wherever possible, whether in primary care, hospital, or home settings. We look forward to building on these efforts in the months and years to come.

Tess Miller is the Acting Director of AHRQ’s Center for Evidence and Practice Improvement. Michael I. Harrison is a senior social scientist in the Center for Evidence and Practice Improvement.

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