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Examining Patient Outcome Quality Indicators Based on Wait Time From Referral to Entry Into Cardiac Rehabilitation


Kehler, Dustin Scott MSc; Kent, Dave BKin; Beaulac, Julie PhD; Strachan, Leisha PhD; Wangasekara, Nilu BSc; Chapman, Soyun BKin; Hiebert, Brett MSc; Lamont, Darlene MSc; Lerner, Neal MD, FRCPC; Boreskie, Sue MPE; Avery, Lorraine PhD; Duhamel, Todd A. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: July 2017 - Volume 37 - Issue 4 - p 250–256
doi: 10.1097/HCR.0000000000000232
Cardiac Rehabilitation

Purpose: The purpose of this study was to examine whether meeting the Canadian Cardiovascular Society (CCS) ≤60-day wait time from cardiac rehabilitation (CR) referral to enrollment is associated with CCS patient-level quality indicator outcomes.

Methods: This pilot observational study consisted of 69 participants entering CR separated into 2 groups based on wait time (≤60-day, n = 45; >60-day, n = 24). Data were collected at baseline, and 1, 4 (CR completion), 6, and 12 months after baseline. Quality indicators for achieving a 0.5 peak metabolic equivalent (MET) improvement at CR completion, physical activity of 150 min/wk of moderate-vigorous physical activity, and CR adherence were assessed. Depressive symptoms were assessed with the Patient Health Questionnaire.

Results: Sixty participants completed the study (≤60-day, n = 40; >60-day, n = 20). In the ≤60-day group, 92% of participants achieved the 0.5 MET improvement upon CR completion; whereas 60% of the >60-day group met this criteria (P ≤ .05). For the 150 min/wk of moderate-vigorous physical activity and CR adherence, both groups were not significantly different at any time. Elevated depressive symptoms were initially observed in 45% of participants in the ≤60-day group and 35% in the >60-day group (NS) and decreased to 8% in the ≤60-day group compared with 30% in the >60-day group at 12 months (P ≤ .05).

Conclusions: Meeting the CCS 60-day acceptable wait time is associated with improvements in METs and depressive symptoms, but not with physical activity or CR adherence. A larger observational study is warranted to explore patient-level CCS quality indicators during and after CR.

The Canadian Cardiovascular Society recommends that clients enroll in cardiac rehabilitation within 60 days from referral. Meeting this recommended wait time is associated with a greater improvement in exercise capacity and a greater reduction in depressive symptoms after cardiac rehabilitation, as compared with patients who wait ≥60 days to enroll.

Faculty of Kinesiology & Recreation Management, Health, Leisure & Human Performance Research Institute, University of Manitoba, Winnepeg, Canada (Messrs Kehler and Kent, Drs Strachan and Duhamel, and Ms Chapman); St. Boniface Hospital Research Centre, Institute of Cardiovascular Sciences, Winnepeg, Manitoba, Canada (Messrs Kehler, Kent, and Wangasekara, Ms Chapman, and Dr Duhamel); Department of Clinical Health Psychology, University of Manitoba, Winnepeg, Canada (Dr Beaulac); St. Boniface General Hospital, Winnipeg, Manitoba, Canada (Mr Hiebert); Reh-Fit Centre, Winnipeg, Manitoba, Canada (Mss Lamont and Boreskie, and Dr Lerner); Winnipeg Regional Health Authority Cardiac Sciences Program, Winnipeg, Manitoba, Canada (Dr Avery); and Department of Physiology, University of Manitoba, Winnipeg, Canada (Dr Duhamel).

Correspondence: Todd A. Duhamel, PhD, 317 Max Bell Center, University of Manitoba, Winnipeg, MB R3T 2N2, Canada (

All authors have read and approved the article.

The authors declare no conflicts of interest.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.