Cardiac Rehabilitation
A comprehensive CVD risk-reduction regimen (eg,
cardiovascular or stroke rehabilitation or a physicianguided
home- or community-based exercise training
program) should be recommended to women with a
recent acute coronary syndrome (ACS) or coronary
revascularization, new onset or chronic angina, recent
cerebrovascular event, peripheral arterial disease, or
current/prior symptoms of heart failure and a left
ventricular ejection fraction (LVEF) of 35%.3
Research has shown that women are less likely to be
referred for cardiac rehabilitation and are more likely
to drop out of a program.11 Some women have
competing social demands or are frequently responsible
for caregiving of others; some believe they can
return to their baseline activity without a formal
program; some are uncomfortable participating in
programs that have a predominantly male enrollment;
and some do not want to participate because
they may have little experience exercising before
their cardiac diagnosis.11
Furthermore, Medicare Part B and insurance
companies reimburse only for certain cardiac diagnoses
(eg, MI in the past 12 months, stable angina, status after
revascularization, valve surgery, or heart/lung transplantation).
For those individuals and conditions
covered, co-pays and deductibles may be prohibitive,
especially if patients are financially challenged.
While NPs are unable to order cardiac rehabilitation
based on current regulations, they have a responsibility
to advocate for referrals and encourage
eligible patients to attend. Strategies to facilitate
referral and increased participation include automatically
referring all eligible patients at the time of
hospital discharge, providing patients with a choice of
where they can attend, providing written invitations
and culturally and age-appropriate program brochures,
arranging for transportation or parking assistance
if needed to attend, following up with those
who are referred yet have not attended, and openly
discussing potential barriers to not enrolling into
cardiac rehabilitation and secondary prevention.