title: An early cardiac access clinic significantly improves cardiac rehabilitation participation and completion rates in low-risk ST-elevation myocardial infarction patients.
abstract: BACKGROUND
  Survivors of an acute ST-elevation myocardial infarction (STEMI) remain at high risk for future cardiac events. Cardiac rehabilitation (CR) participation significantly reduces coronary artery disease (CAD) morbidity and mortality risk. Regrettably, poor utilization of CR services post STEMI is common, accentuating a critical action gap in the trajectory of CAD management. The objective of this study was to determine whether integration of an early cardiac access clinic (ECAC), held within 4-14 days of hospital discharge, could improve CR utilization rates following an STEMI.
  
  
  METHODS
  Between January 2008 and July 2009, 245 consecutively admitted STEMI patients (19.6% female) deemed low risk following early re-establishment of coronary blood flow, were assigned to the ECAC model. An historic comparison group (n=224) was identified based on all STEMI patient admissions at the same tertiary care facility during the 2007 calendar year that met ECAC eligibility criteria. The primary outcomes were rates of CR referral, orientation attendance, program participation, and completion.
  
  
  RESULTS
  The ECAC cohort had significantly higher rates of CR referral (100% vs 55.8%, P < 0.0001), orientation attendance (96.3 vs 37.1%, P < 0.0001), program participation (87.8% vs 33.5%, P < 0.0001), and completion (71.4% vs 29.9%, P < 0.001) compared to the matched historical comparison group.
  
  
  CONCLUSIONS
  The utilization of the ECAC model resulted in an unprecedented (∼3-fold) increase in the number of post-STEMI patients participating in CR. Given the unequivocal mortality and morbidity benefits of CR, adoption of the ECAC model has important clinical and economic relevance.
authors.affiliation: Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada. Karen.Parker@saskatoonhealthregion.ca
authors.forename: Karen
authors.initials: K
authors.lastname: Parker
authors.forename: James A
authors.initials: JA
authors.lastname: Stone
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.forename: Debra
authors.initials: D
authors.lastname: Lundberg
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.forename: David
authors.initials: D
authors.lastname: Goodhart
authors.forename: Mouhieddin
authors.initials: M
authors.lastname: Traboulsi
mesh_terms: D004562:Electrocardiography; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000534:rehabilitation*; D012307:Risk Factors; D013997:Time Factors