1. Heather Christensen Kinesiology Major California State University – Monterey Bay Today’s Healthcare Professionals

2. American Detriment 1 in 3 Americans have cardiovascular disease (CVD) Billions of dollars in healthcare costs Cardiac rehabilitation (cardiac rehab) is cheap Cardiac rehab works

4. Hurdles to Heart Health Lack of referrals Under referred populations Physician support = Patient participation Patient Barriers Approximately 40% attend cardiac rehab (Farley et al., 2003, p. 208) Patients feel they can ‘deal with it on their own’

5. Factors Associated with Limited Referral and Enrollment in Cardiac Rehabilitation/Secondary Prevention Programs (CR/SPP) Patient Oriented Factors Female sex Older age Race/ethnic minority group Low socioeconomic status Low educational attainment Low self-efficacy Low health literacy Lack of perceived need for CR/SPP Work related factors (job flexibility, loss of salary, self employment, and lack of healthcare/disability benefits) Limited social support Home responsibilities Medical Factors Multiple comorbidities including depression and musculoskeletal conditions Healthcare System Factors Lack of referral Lack facilitation of enrollment after referral Strength of the endorsement of CR/SPP by the patients physician Program availability and characteristics Lack of program that serves specific geographic areas, including rural areas and low-income communities Distance of CR/SPP for patient’s home Hours of operation Parking and public transportation access Table adapted from: Balady, G., Ades, P., Bittner, V., Franklin, B., Gordon, N., Thomas, R.,…Yancy, C., (2011). Referral enrollment and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A presidential advisory from the American Heart Association. Circulation. 124. 2952. doi: 10.1161/CIR.0b013e31823b21e2

6. Eligible Patients

7. Non Referred Eligible Patients

8. Non Referred and Non Attending Eligible Patients

9. 2 in 10 Eligible Patients Participating

10. Beneficial Outcomes of Proper Cardiac Care Physical impairments/ Morbidity/ Cardiac event risks Focus on exercise Cardiac rehab better than drugs (Farley et al. 2003, p. 205) BENEFITS OF EXERCISE OUTWEIGHT RISKS!!!

11. Beneficial Outcomes of Proper Cardiac Care Quality of Life (QOL) Cardiac rehab goals: Increase “functional capacity” Older adults “reduce frailty” (Dorosz, 2009, p. 726) Reemployment 35% do not return to work Program design could increase reemployment Decrease burden on society

12. Promoting the Means to a Better Life Systematic Referral plus Liaison Increase referral of females, minorities, and low socioeconomic populations Referral + liaison= 66% increase in enrollment Health team support and enthusiasm Options: Home based vs. Center based Home based program effective and safe

13. We Can Increase Utilization of Cardiac Rehab by: 1. Promoting the use of systematic referral 1. Advocating cardiac rehab to heart patients 1. Understanding options

14. Thank You!! Questions/Comments

15. References Balady, G., Ades, P., Bittner, V., Franklin, B., Gordon, N., Thomas, R., Tomaselli, G., & Yancy, C. (2011). Referral, enrollment and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A Presidential advisory from the American Heart Association. Circulation, 124, 2951-2960. doi:10.1161/CIR.0b013e31823b21e2 Dorosz, J. (2009). Updates in cardiac rehabilitation. Physical Medicine and Rehabilitation Clinics of North America. 20. 719-736. doi: 10.1016/j.pmr.2009.06.006 Farley, R., Wade, T., & Birchmore, L. (2003). Factors influencing attendance at cardiac rehabilitation among coronary heart disease patients. European Journal of Cardiovascular Nursing, 2, 205-212. doi:10.1016/S1474-5151(03)00060-4