Rationale: Cardiologists are the most frequent referrers to cardiac rehabilitation (CR), a proven means of secondary prevention. Yet CR is grossly underutilized, due to multiple factors including physician awareness of CR sites and patient barriers such as travel time and distance.

Objective: To explore the number of CR sites of which cardiologists are aware, and the number of sites to which they refer patients.

Methods: Ninety-seven cardiologists (83 [85.6%] male; 62 [63.9%] internists) within major Ontario centers with CR programs completed an open-ended survey to report the CR sites in their area, and the sites to which they have referred.

Results: Cardiologists were aware of (mean +/- SD) of 1. 9 +/- 1.1 CR sites in their area, with a median of 1 and a range of 0-4 sites. Forty-six (47.4%) cardiologists were aware of 1 CR site, 19 (19.6%) were aware of 2 sites, 16 (16.5%) of 3 sites, and 10 (10.3%) were aware of 4 sites, with 6 (6.2%) not responding or unaware of any sites. Cardiologists referred to 1.8 +/- 1.0 CR sites. Forty-seven (48.5%) cardiologists referred to 1 CR site, 25 (25.8%) referred to 2 sites, 9 (9.3%) to 3 sites, and 10 (10.3%) referred to 4 sites, with 6 (6.2%) not responding or not referring to any sites. There was 54.2% (Cohen's[kappa]) agreement between the number of sites for awareness and referral.

Conclusions: Approximately three quarters of cardiologists are aware of and refer to only 1-2 CR sites, which is disconcerting given the concentration of approximately 50 CR sites in Southern Ontario. Use of geographical software to test the appropriateness of these findings is warranted. Results suggest that referring cardiologists may develop a relationship with one CR program, and thus their patients may be traveling farther than the closest CR site to receive services. CR marketing to physicians, as well as the development of a centralized referral process, may ameliorate this situation.