Ambulatory Surveillance of Patients Referred for Cardiac Rehabilitation Following Cardiac Hospitalization: A Feasibility Study

Purpose: To examine the feasibility of implementing an ambulatory surveillance system for the monitoring of patients referred to cardiac rehabilitation following cardiac hospitalizations. Methods: This study consists of 1208 consecutive referrals to cardiac rehabilitation between October 2007 and April 2008. Patient attendance to cardiac rehabilitation, waiting-times for cardiac rehabilitation, and adverse events while waiting for cardiac rehabilitation were tracked by telephone surveillance by a nurse. Results: Among the 1208 consecutive patients referred, only 44.7% of referred patients attended cardiac rehabilitation; 36.4% of referred patients were known not to have attended any cardiac rehabilitation, while an additional 25.8% of referred patients were lost to follow-up. Among the 456 referred patients who attended the cardiac rehabilitation program, 19 (4.2%) experienced an adverse event while in the queue (13 of which were for cardiovascular hospitalizations with no deaths) with mean waiting times of 20 days and 24 days among those without and with adverse events, respectively. Among the 440 referred patients who were known not to have attended any cardiac rehabilitation program 114 (25.9%) had adverse clinical events while in the queue; 46 (10.4%) of these events required cardiac hospitalization and 8 (2%) patients died. Conclusions: Ambulatory surveillance for cardiac rehabilitation referrals is feasible. The high adverse event rates in the queue, particularly among patients who are referred but who do not attend cardiac rehabilitation programs underscores the importance of ambulatory referral surveillance systems for cardiac rehabilitation following cardiac hospitalizations.