Cardiovascular rehabilitation, while long known to offer significant benefits for recovering cardiac patients, is poorly attended. The intervention is heavily evidence-based; a recent study found cardiac rehabilitation may decrease 10-year death risk by as much as 46 percent. Given the potential benefits of this rehabilitation, hospitals have put a lot of thought into how to up participation.
"Preventive cardiology is very important," says Steven Keteyian, PhD, program director of preventive cardiology, at the Detroit-based Henry Ford Health System. “But it's also frequently overlooked. Often, high-end [medical equipment] items get a lot of the capital over things like cardiac rehab," he says.
According to Dr. Keteyian, the practice of cardiac rehabilitation began in earnest 35 years ago, when clinical trials began to show the process has tangible benefits. Now, while there is no evidence gap, there is a troubling user gap for rehabilitation; identifying good candidates for cardiac rehabilitation and getting them into the system as soon as possible is crucial to bridging it.
Henry Ford Health System is currently piloting a new cardiac rehabilitation system, Care4Today™ Heart Health Solutions, created by Janssen Healthcare Innovation, in order to increase its rehabilitation participation rates.
"We have to find patients while interest [in rehabilitation] is still high," Dr. Keteyian says. "For every day we wait, there is a one percent drop in overall participation. We've spent years on verifying this model."
Accordingly, Henry Ford's pilot of Janssen's program is based on the idea that quick rehabilitation enrollment is the key to success. The program consists of technological platforms a multimedia educational system, and centralized data capture, all of which are designed to make access to and presentation of information easier for patients and providers.
The program's software starts the intervention process each day by checking which patients at Henry Ford were just discharged from cardiovascular care. They use this information to create a core group of people eligible for rehabilitation. The data is then loaded into a custom technology platform, where each patients' medical records can be grouped together and can be easily accessed by the rehab team.
"The success of the intervention is based on early stripping and quick loading," said Dr. Keteyian. "It shifted our [rehabilitation] start time [after discharge] from a median of 27 days to a median of 18 days within six months of starting the intervention." He says Henry Ford's new enrollment goal is between 8 and 11 days post-discharge.
With strides made on improved enrollment, the program is now focused on retention. "We don't have conclusive data yet, but we want to retain patients longer. More rehabilitation shows a better clinical outcome. The biggest question is how do we grab and retain them, so to speak," he says.
Dr. Keteyian says the reasons people aren't retained are numerous; they may include age, gender, parental responsibilities, work, cost of co-pays and even lack of insurance.
According to Logan Morse, Jansen Healthcare Innovation's commercial trial leader for the heart health solutions program, the intervention stresses behavior modification, which helps patients continue rehabilitation. The intervention keeps an interactive mindset in play to improve retainment, including text-messaging, overhauled educational material, lectures and social cohesion through an interactive class time with other rehabilitation patients.
The educational component is in five core areas — anatomy, nutrition, spiritual well-being, goal-setting and base-level education about the heart condition itself — that may be practical for patients. The group-centricity of the intervention has improved its effectiveness, which has allowed providers to be more productive in other areas.
Dr. Keteyian says that over the last five years the traditional concept of what it means to be discharged from a hospital is changing. If hospitals focus on getting patients into rehabilitation early enough, he suspects they could make significant progress in changing patients' lives through cardiac rehabilitation.
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