Referral strategy led to high rate of cardiac rehabilitation use
Grace S. Arch Intern Med. 2011;171:235-241.
Automatic referral combined with a liaison referral resulted in the highest rates of cardiac rehabilitation use among patients in a prospective controlled study.
Researchers in the Canadian study enrolled 2,635 inpatients with CAD from 11 Ontario hospitals and referred them to one of 52 cardiac rehabilitation programs. Patients were asked to complete a sociodemographic survey, and clinical data were obtained from medical charts. After 1 year, patients were then sent a follow-up survey that assessed self-reported cardiac rehabilitation referral, enrollment and participation, of which 1,809 patients responded.
According to study data, adjusted analyses indicated that referral strategy was significantly related to cardiac rehabilitation referral and enrollment (P<.001), with the greatest cardiac rehabilitation use found in the combined automatic and liaison referral strategy (OR=8.41; 85.8% referral, 73.5% enrollment) when compared with usual referral (32.2% referral, 29% enrollment). Other strategies showing high cardiac rehabilitation use when compared with usual referral were automatic only (OR=3.27; 70.2% referral, 60% enrollment) and liaison only (OR=3.35; 59% referral, 50.6% enrollment).
The results of this study, when combined with the results of a recent systematic review of the field, the researchers wrote, suggest that wider adoption of combined automatic- and liaison-based referral strategies should be promoted.
“Discussion with health care providers involved in cardiac rehabilitation referral at participating institutions revealed that this combination of strategies may be most effective because it targets the health care provider and patient,” they said. “Implementation could potentially raise cardiac rehabilitation use 45% (range, 29.1%-74%), suggesting that major public health gains could be achieved in the population being treated for cardiac disease.”
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Prognostic impact of no-reflow following acute myocardial infarction
An article from the e-journal of the ESC Council for Cardiology Practice
Conclusion
Contrast-enhanced CMR is a useful non-invasive technique for assessing the presence and extent of microvascular obstruction. No-reflow phenomenon has important prognostic implications, and the use of CMR can help to identify and quantify areas of microvascular damage in patients with STEMI. It could become a powerful tool to stratify the risk of patients and in future to differentiate the effectiveness of different techniques of reperfusion.
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