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Cardiac Rehabilitation in a Rural Setting


Frechette, Kristen M. BA, RN; Conley, Sheila M. BSN, RN; Tang, Austin MPH; Welch, Terrence D. MD, FACC, FASE

Journal of Cardiopulmonary Rehabilitation and Prevention: January 2019 - Volume 39 - Issue 1 - p E4–E7
doi: 10.1097/HCR.0000000000000386
Brief Reports

Purpose: The cardiac rehabilitation (CR) program at Dartmouth-Hitchcock Medical Center (DHMC) devotes a nurse to the inpatient units in an attempt to optimize the referral process. This report defines the rates of referral and participation at DHMC and explores potential factors that affect participation.

Methods: Seven hundred ten consecutive patients who underwent percutaneous coronary intervention, coronary artery bypass grafting, or valve surgery from January 1, 2015 to June 30, 2015 were reviewed to determine whether the patient was referred for CR. Participation rates and the effect of time delay and patient-specific factors on participation were examined.

Results: Six hundred ninety-eight (98%) of the 710 post-procedural patients were evaluated by the inpatient rehabilitation nurse. One hundred sixty-seven patients were ineligible for outpatient therapy on the basis of established criteria; the remaining 543 patients were referred to DHMC or regional rehabilitation programs. Of those referred to the on-site program at DHMC, 84% participated. Of those referred to regional programs, 60% participated. There was an inverse correlation (r = −0.82; P = .003) between wait times and participation rates for the various programs.

Conclusions: Despite its rural location with a large geographic catchment area, DHMC achieves high rates of CR referral and participation. The approach used at DHMC, which includes a CR nurse working with the inpatient cardiac services, a strong level of integration with the physician community, and well-developed relationships with regional rehabilitation programs, may be helpful for those programs wishing to improve referral and participation rates. Shorter wait times between hospital discharge and initiation of rehabilitation may improve participation rates.

Dartmouth-Hitchcock Medical Center achieves high rates of cardiac rehabilitation referral and participation in a rural setting, likely due to having a dedicated nurse on the inpatient units, a strong level of integration with the physician community, and well-developed relationships with regional rehabilitation programs. Shorter wait times may improve participation rates.

Section of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, New Hampshire (Mss Frechette and Conley and Dr Welch); Keck School of Medicine of USC, Los Angeles, California (Mr Tang); and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Dr Welch).

Correspondence: Terrence D. Welch, MD, FACC, FASE, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03755 (

The authors declare no conflicts of interest.

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