title: Ambulatory surveillance of patients referred for cardiac rehabilitation following cardiac hospitalization: a feasibility study.
abstract: BACKGROUND
  Our purpose was to examine the feasibility of implementing an ambulatory surveillance system for monitoring patients referred to cardiac rehabilitation following cardiac hospitalizations.
  
  
  METHODS
  This study consists of 1208 consecutive referrals to cardiac rehabilitation between October 2007 and April 2008. Patient attendance at cardiac rehabilitation, waiting times for cardiac rehabilitation, and adverse events while waiting for cardiac rehabilitation were tracked by telephone surveillance by a nurse.
  
  
  RESULTS
  Among the 1208 consecutive patients referred, only 44.7% attended cardiac rehabilitation; 36.4% of referred patients were known not to have attended any cardiac rehabilitation, while an additional 18.9% of referred patients were lost to follow-up. Among the 456 referred patients who attended the cardiac rehabilitation program, 19 (4.2%) experienced an adverse event while in the queue (13 of which were for cardiovascular hospitalizations with no deaths), with mean waiting times of 20 days and 24 days among those without and with adverse events, respectively. Among the 440 referred patients who were known not to have attended any cardiac rehabilitation program, 114 (25.9%) had adverse clinical events while in the queue; 46 of these events required cardiac hospitalization and 8 patients died.
  
  
  CONCLUSIONS
  Ambulatory surveillance for cardiac rehabilitation referrals is feasible. The high adverse event rates in the queue, particularly among patients who are referred but who do not attend cardiac rehabilitation programs, underscores the importance of ambulatory referral surveillance systems for cardiac rehabilitation following cardiac hospitalizations.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. david.alter@ices.on.ca
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.forename: Juda
authors.initials: J
authors.lastname: Habot
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Terry
authors.initials: T
authors.lastname: Fair
authors.forename: David
authors.initials: D
authors.lastname: Kiernan
authors.forename: Wendy
authors.initials: W
authors.lastname: Clark
authors.forename: David
authors.initials: D
authors.lastname: Fell
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000534:rehabilitation*; D001026:Coronary Artery Bypass / Q000401:mortality / Q000534:rehabilitation*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000534:rehabilitation*; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000534:rehabilitation*; D009864:Ontario; D010359:Patient Readmission / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D012017:Referral and Consultation; D016019:Survival Analysis; D014850:Waiting Lists