Johns Hopkins Hospital, Baltimore, MD (A.I.M.).
Department of Internal Medicine, Division of Cardiovascular Medicine (M.S., M.C., H.S.G., D.S.), University of Michigan, Ann Arbor.
Circ Cardiovasc Qual Outcomes. 2024 Oct;17(10):e010874. doi: 10.1161/CIRCOUTCOMES.124.010874. Epub 2024 Oct 4.
Cardiac rehabilitation (CR) improves outcomes following percutaneous coronary intervention (PCI) but remains underutilized. A liaison-mediated referral (LMR), where a health care professional explains CR's benefits, addresses barriers to participation, and places a referral before discharge, may promote CR use. Our objective was to assess the impact of an LMR on CR participation after PCI.
This was a retrospective study of patients who underwent PCI across 48 hospitals in Michigan between January 2021 and April 2022 and referred to CR before discharge. Clinical registry data were linked to administrative claims to identify the primary outcome, CR participation, defined as ≥1 CR session within 90 days of discharge. Bayesian hierarchical logistic regression was used to compare CR participation between patients with and without an LMR. For the secondary outcome, frailty proportional hazard modeling compared days elapsed between discharge and first CR session between liaison cohorts.
Among 9023 patients referred to CR after PCI, 4323 (47.9%) underwent an LMR (mean age, 69.3 [SD=11] years; 68.3% male) and 3390 (36.7%) attended ≥1 CR session within 90 days of discharge. The LMR cohort had a higher unadjusted CR participation rate (43.1% [95% CI, 41.5%-44.6%] versus 32.4% [95% CI, 31.1%-33.8%]; <0.001), a higher adjusted odds ratio of attending ≥1 CR session (adjusted odds ratio, 1.21; 95% credible interval, 1.07-1.38), and a shorter delay in attending the first CR session compared with the non-LMR cohort (28 [interquartile range, 19-42] versus 33 [interquartile range, 21-47] days; <0.001).
An LMR was associated with higher odds of CR participation and may mitigate delays in CR enrollment. This referral strategy may improve CR participation and patient outcomes after PCI.
心脏康复（CR）可改善经皮冠状动脉介入治疗（PCI）后的结局，但仍未得到充分利用。联络介导转诊（LMR），即医疗保健专业人员解释 CR 的益处、解决参与障碍并在出院前进行转诊，可能会促进 CR 的使用。我们的目的是评估 PCI 后 LMR 对 CR 参与的影响。
这是一项回顾性研究，纳入 2021 年 1 月至 2022 年 4 月期间在密歇根州 48 家医院接受 PCI 治疗并在出院前转诊至 CR 的患者。临床登记数据与行政索赔数据相关联，以确定主要结局，即出院后 90 天内至少参加 1 次 CR 治疗。采用贝叶斯分层逻辑回归比较有和无 LMR 的患者的 CR 参与情况。对于次要结局，采用脆弱性比例风险模型比较联络组中从出院到首次 CR 治疗的天数。
在 9023 例被转诊至 CR 的 PCI 后患者中，4323 例（47.9%）接受了 LMR（平均年龄 69.3[SD=11]岁；68.3%为男性），3390 例（36.7%）在出院后 90 天内至少参加了 1 次 CR 治疗。LMR 组的未调整 CR 参与率更高（43.1%[95%CI，41.5%-44.6%]与 32.4%[95%CI，31.1%-33.8%]；<0.001），调整后参加至少 1 次 CR 治疗的优势比更高（调整优势比，1.21；95%可信区间，1.07-1.38），且首次参加 CR 治疗的时间延迟更短（28[四分位距，19-42]与 33[四分位距，21-47]天；<0.001）。
LMR 与更高的 CR 参与率相关，并可能减轻 CR 登记的延迟。这种转诊策略可能会改善 PCI 后 CR 的参与度和患者结局。
