Purpose:

It is well established that outpatient cardiac rehabilitation (CR) programs are underutilized. Although low rates of physician referral and poor coordination of inpatient to outpatient care are significant obstacles to utilization, prior studies have largely focused on patient-related factors. There is little known about programmatic issues from the program director's perspective. In addition, several CR and pulmonary rehabilitation (PR) programs located on Long Island have recently closed, which prompted this study of salient factors threatening program viability in New York.

Methods:

A mailed self-report survey was completed by 33 CR and/or PR program directors representing 31 programs (29 CR and/or 8 PR) operating throughout Long Island and Greater New York in Spring 2005.

Results:

The PR programs served a mean of 126 patients (range = 10 to 400) and the CR programs served a mean of 250 patients (range = 30 to 918) in 2004; the mean % of non-white patients per program was 5% African American and 3% Hispanic, and the mean % of women was only 30% - 45% (CR - PR). The mean % of patients referred who enrolled was 80%, with the majority referred by outpatient cardiologists (CR) and pulmonologists (PR). Most CR directors (54%) stated that none of the hospitals they primarily deal with have referral on discharge plans for MI or CABG, and 15% were unaware of discharge procedures. Most PR programs are operating at full capacity (72%) yet most CR programs are not (54%). Physicians reportedly tend not to refer patients in part due to a lack of knowledge about program location and availability. Recommendations to overcome barriers to utilization: simplify referral and enrollment procedures, advertise, and educate physicians in inpatient and outpatient settings.

Conclusions:

The data provide an in-depth analysis of modifiable factors that affect CR and PR program viability. Further study also should explore gender and race/ethnic disparities in utilization.