title: An early appointment to outpatient cardiac rehabilitation at hospital discharge improves attendance at orientation: a randomized, single-blind, controlled trial.
abstract: BACKGROUND
  Outpatient cardiac rehabilitation (CR) decreases mortality rates but is underutilized. Current median time from hospital discharge to enrollment is 35 days. We hypothesized that an appointment within 10 days would improve attendance at CR orientation.
  
  
  RESULTS
  At hospital discharge, 148 patients with a nonsurgical qualifying diagnosis for CR were randomized to receive a CR orientation appointment either within 10 days (early) or at 35 days (standard). The primary end point was attendance at CR orientation. Secondary outcome measures were attendance at ≥1 exercise session, the total number of exercise sessions attended, completion of CR, and change in exercise training workload while in CR. Average age was 60±12 years; 56% of participants were male and 49% were black, with balanced baseline characteristics between groups. Median time (95% confidence interval) to orientation was 8.5 (7-13) versus 42 (35 to NA [not applicable]) days for the early and standard appointment groups, respectively (P<0.001). Attendance rates at the orientation session were 77% (57/74) versus 59% (44/74) in the early and standard appointment groups, respectively, which demonstrates a significant 18% absolute and 56% relative improvement (relative risk, 1.56; 95% confidence interval, 1.03-2.37; P=0.022). The number needed to treat was 5.7. There was no difference (P>0.05) in any of the secondary outcome measures, but statistical power for these end points was low. Safety analysis demonstrated no difference between groups in CR-related adverse events.
  
  
  CONCLUSIONS
  Early appointments for CR significantly improve attendance at orientation. This simple technique could potentially increase initial CR participation nationwide.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01596036.
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit MI, USA.
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.forename: Mouhamad
authors.initials: M
authors.lastname: Mansour
authors.forename: Joaquim S
authors.initials: JS
authors.lastname: Barboza
authors.forename: Brooks A
authors.initials: BA
authors.lastname: Hibner
authors.forename: Meredith G
authors.initials: MG
authors.lastname: Mahan
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Ehrman
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Vanzant
authors.forename: John R
authors.initials: JR
authors.lastname: Schairer
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D005081:Exercise Therapy; D005260:Female; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D016037:Single-Blind Method; D014481:United States