Cardiac Rehabilitation Knowledge and Attitudes of Cardiology Fellows

Abstract

Purpose: Cardiac rehabilitation (CR) is underutilized with only 8-31% of eligible patients participating. Lack of referral and lack of physician endorsement are well-known barriers to participation. Physicians who lack insights regarding CR are less likely to refer patients and recommend it. Cardiology fellows are early career physicians who spend a significant amount of time treating patients eligible for CR. At one institution's cardiology fellowship program, we sought to assess fellow attitudes and knowledge base regarding CR and to determine their facilitators and barriers to CR endorsement and referral. Methods: University of Pittsburgh Department of Medicine Cardiology fellows were surveyed and interviewed to assess CR knowledge, attitudes, and perceived facilitators and barriers to CR endorsement and referral. Results: The cardiology fellows at this institution had strong belief in the benefits and cost-effectiveness of CR. Despite their support of CR, they had low CR knowledge scores. Perceived impediments to CR included complicated logistics of CR operations, limited communication between CR staff and fellows, limited time with patients, presumed patient barriers, perceived self-barriers, and poor understanding of referral processes (particularly as they varied in each hospital in which they rotated). Perceived supports to CR included greater awareness of evidence-based outcomes, awareness of patient-centered outcomes, pre-arranged order sets, and reminders for referral. Conclusion: This study revealed perceptions of cardiology fellows at one institution regarding CR that have not been considered previously. Key barriers to endorsement and referral to CR were exposed as well as opportunities to overcome them. Fellowship training affords an important opportunity to improve CR education, and to potentially improve participation of eligible patients for this important aspect of care.

Internal medicine resident education improves cardiac rehabilitation knowledge, attitudes, and referral rates: A pilot study

“…These findings suggest that structured resident education on CR is effective in addressing physician knowledge gaps and has a role in changing referral habits in trainees. A previous study of cardiology fellowship trainees had similar findings of low CR knowledge scores and poor understanding of the physician referral processes [18] . Further, the majority of the internal medicine residents reported that they did not receive any formal education on CR over the past 1 year during their residency training.…”

“…Knowledge questions consisted of multiple correct and incorrect possibilities and were adapted from a survey used in a prior study of cardiology fellowship trainees [18] . Survey questions were replicated with the exception of demographic questions, which were adjusted to account for the difference in level of training.…”

To what extent are comorbidity profiles associated with referral and uptake to cardiac rehabilitation

“…Our results suggest that referral seems to be less affected by the individual patient characteristics e.g. comorbidity, and might instead be more related to organizational elements and CR knowledge and endorsement from health care professionals (12,37,38).…”

Prevalence of US Adults With Cardiovascular Disease Reporting Barriers to Clinician Office Visits

“…Barriers to CR participation and adherence are numerous and can include the following: lack of local CR programs, lack of referral and enrollment, transportation, physical limitations, competing demands, comorbidities, living alone, fear of exercise, and cost, among others. [8][9][10][11][12][13][14] The most vulnerable populations that are underrepresented in CR programs include older adults, women, ethnic minorities, veterans, and individuals with low socioeconomic status representing many social determinants of health (SDOH). 6,8,10,13,[15][16][17] Importantly, the current pandemic has posed a significant barrier to CR participation as many of the already limited number of center-based CR programs in the US have suspended or reduced services to limit contagion.…”