Disparities in Cardiac Rehabilitation Referral for Patients with Myocardial Infarction in the United States

Background: Each year an estimated 635,000 Americans experience a myocardial infarction (MI) and a treatment that has been shown to decrease mortality is cardiac rehabilitation. Proposed federal legislation, S.488, supports nurse practitioners and clinical nurse specialists to meet "direct supervision" requirements for cardiac rehabilitation programs. If passed, nurse leaders will need to work closely with hospitals to ensure all eligible MI patients are referred.Objective: To identify demographic and clinical characteristics of MI patients associated with lower cardiac rehabilitation referral rates in a national U.S. cohort.Methods: This was a retrospective cohort analysis using 2011-2015 data from the American College of Cardiology’s ACTION Registry-GWTGs. The cohort included 507,793 MI patients from 851 U.S. hospitals. Patients were stratified by referral versus non-referral and patient demographics and clinical characteristics were compared using χ2 tests (p<.05).Results: A total of 78% (n=395,948) of patients were referral for cardiac rehabilitation. Patients aged ≥80 years (70.9%, n=44,918, p≤.001) had the lowest rate of age groups. Women (75.2%, n= 123,191) had significantly lower referral rates compared to men (79.3%, n= 272,757) (χ2 = 1110.168, p ≤ .001). Hispanic patients (65.5%, n=19,149) had the lowest referral rate of all race/ethnicity groups. Referral rates were significantly lower for patients without PCI (64.4%, n=99,364) or CABG (76.7%, n=354,945) during admission compared to those with PCI and CABG (83.9%, n=296,584, p ≤ .001 and 76.7%, n=354,945, p≤001 respectively).Conclusions: Patients who were aged ≥80 years, Hispanic, or did not receive a PCI or CABG had lower referral rates. These results support a gap in referral for cardiac rehabilitation remains and there’s a need for quality improvement.