Cardiac rehabilitation referral strategies: effects on referral and enrollment

Despite recommendations in clinical practice guidelines, evidence suggests cardiac rehabilitation (CR) utilization following indicated cardiac events is 15-20%. Referral strategies such as automatic referral have been advocated to improve CR utilization. This Review evaluated the effects of referral strategies on CR referral and enrollment. Referral strategies were categorized as ‘automatic’ based on use of electronic health records or systematic discharge order sets, as ‘liaison’ based on discussions with allied healthcare providers, or ‘other’. The highest rates of CR referral were achieved in studies implementing automatic referral orders, where referral reached 85%. The highest rates of CR enrollment were achieved with a combination of automatic and liaison methods (78% and 86%). Although there were some null findings, overall results suggest that innovative referral strategies significantly increase CR utilization. Automatic referral methods, such as the ‘Get With the Guidelines’ initiative, show promise for improving referral rates. The additional incorporation of a CR discussion resulted in enrollment rates that are double the rates seen after usual referral. While further investigation is needed, institutions should evaluate their CR referral practice in light of these findings.