Cardiac Rehabilitation Patient Referral from an Outpatient Setting

Measure Specification

Cardiac rehabilitation services have been shown to help reduce morbidity and mortality in persons who have experienced a recent coronary artery disease event, but these services are used in less than 30% of eligible patients (1). A key component to CR utilization is the appropriate and timely referral of patients to an outpatient CR program. While referral takes place generally while the patient is hospitalized for a qualifying event (MI, CSA, CABG, PCI, cardiac valve surgery, or heart transplantation), there are many instances in which a patient can and should be referred from an outpatient clinical practice setting (e.

g., when a patient does not receive such a referral while in the hospital, or when the patient fails to follow through with the referral for whatever reason). This performance measure has been developed to help health care systems implement effective steps in their systems of care that will optimize the appropriate referral of a patient to an outpatient CR program.

This measure is designed to serve as a stand-alone measure or, preferably, to be included within other performance measurement sets that involve disease states or other conditions for which CR services have been found to be appropriate and beneficial (e.g., following MI, CABG surgery) (2, 3). This performance measure is provided in a format that is meant to allow easy and flexible inclusion into such performance measurement sets.

Referral of appropriate outpatients to a CR program is the responsibility of the health care provider within a health care system that is providing the primary cardiovascular care to the patient in the outpatient setting.

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization (ACC/AHA/SCAI, 2022) Class 1 In patients who have undergone revascularization, a comprehensive cardiac rehabilitation program (home based or center based) should be prescribed either before hospital discharge or during the first outpatient visit to reduce deaths and hospital readmissions and improve quality of life.

(Level of Evidence: A) 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (4) Class I Cardiac rehabilitation is recommended for all eligible patients after CABG. (Level of Evidence: A) 2013 ACC/AHA Guideline for the Management of ST-Elevation Myocardial Infarction (5) Class I Exercise-based cardiac rehabilitation/secondary prevention programs are recommended for patients with STEMI.

(Level of Evidence: B) 2014 ACC/AHA Guideline for the Management of Patients with Non–ST-Segment Elevation Acute Coronary Syndromes (6) Class I All eligible patients with NSTE-ACS should be referred to a comprehensive cardiovascular rehabilitation program either before hospital discharge or during the first outpatient visit. (Level of Evidence: B) 2012 ACCF/AHA/ ACP/AATS/PCNA/SCAI/STS Guideline for the Management of Patients with Stable Ischemic Heart Disease (7) Class I Medically supervised programs (cardiac rehabilitation) and physician-directed, home-based programs are recommended for at-risk patients at first diagnosis.

(Level of Evidence: A) Effectiveness-based Guidelines for the Prevention of Cardiovascular Disease in Women — 2011 update: A Guideline from the American Heart Association (9) Class I A comprehensive CVD risk-reduction regimen such as cardiovascular or stroke rehabilitation or a physician-guided home- or community-based exercise training program should be recommended to women with a recent acute coronary syndrome or coronary revascularization, new-onset or chronic angina, recent cerebrovascular event, peripheral arterial disease (Class I; Level of Evidence A) or current/prior symptoms of heart failure and an LVEF ≤ 35%.

(Class I; Level of Evidence B) 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention (10) Class I Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.