Sherry L. Grace, Patricia Scholey, Neville Suskin, Heather M. Arthur, Dina Brooks, Susan Jagla, Beth L. Abramson and Donna E. Stewart
DOI: 10.2340/16501977-0046

Objective: Cardiac rehabilitation remains grossly under-utilized despite its proven benefits. This study prospectively compared verified cardiac rehabilitation enrollment follow­ing automatic vs usual referral, postulating that automatic referral would result in significantly greater enrollment for cardiac rehabilitation.
Design: Prospective controlled multi-center study.
Patients and methods: A consecutive sample of 661 patients with acute coronary syndrome treated at 2 acute care centers (75% response rate) were recruited, one site with automatic referral via a computerized prompt and the other with a usual referral strategy at the physician’s discretion. Cardiac rehabilitation referral was discerned in a mailed survey 9 months later (n = 506; 84% retention), and verified with 24 cardiac rehabilitation sites to which participants were referred.
Results: A total of 124 (52%) participants enrolled in cardiac rehabilitation following automatic referral, vs 84 (32%) following usual referral (p < 0. 001). Automatically referred participants were more likely to be referred from an in-
patient unit (p < 0. 01), and to be referred in a shorter time period (p < 0. 001). Logistic regression analyses revealed that, after controlling for sociodemographic characteristics and case-mix, automatically referred participants were significantly more likely to enroll in cardiac rehabilitation (odds ratio = 2. 1; 95% confidence interval 1. 4–3. 3) than controls.
Conclusion: Automatic referral resulted in over 50% verified cardiac rehabilitation enrollment; 2 times more than usual referral. It also significantly reduced utilization delays to less than one month.