title: The current and potential capacity for cardiac rehabilitation utilization in the United States.
abstract: OBJECTIVE
  Prior studies suggest that program capacity restraints may be an important reason for outpatient cardiac rehabilitation (CR) underutilization. We sought to measure current CR capacity and growth potential.
  
  
  METHODS
  We surveyed all CR program directors listed in the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) database in November 2012. Respondents reported current enrollment levels, program capacity, expansion potential, and obstacles to growth.
  
  
  RESULTS
  Of the 812 program directors in the AACVPR database, 290 (36%) completed the full survey. Respondents represented somewhat larger programs than nonrespondents but were otherwise representative of all registered AACVPR programs. Current enrollment, estimated capacity, and estimated expansion capacity were reported at a median (interquartile range) of 140 (75, 232), 192 (100, 300), and 240 (141, 380) patients annually, respectively. Using these data, we estimated that, in the year 2012, national CR utilization was 28% (min, max: 20, 38) of eligible patients. Even with modest expansion of all existing programs operating at capacity, a maximum of 47% (min, max: 32, 67) of qualifying patients in the United States could be serviced by existing CR programs. Obstacles to increasing patient participation were primarily controllable system-related problems such as facility restraints and staffing needs.
  
  
  CONCLUSIONS
  Even with substantial expansion of all existing CR programs, there is currently insufficient capacity to meet national service needs. This limit probably contributes to CR underutilization and has important policy implications. Solutions to this problem will likely include the creation of new CR programs, improved CR reimbursement strategies, and new models of CR delivery.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Lopez-Jimenez, Thomas, and Zysek); Department of Cardiovascular Medicine, Baystate Medical Group, Springfield, Massachusetts (Dr Pack); Tufts University School of Medicine, Boston, Massachusetts (Dr Pack); Department of Cardiology, Helen Hayes Hospital, West Haverstraw, New York (Dr Lichtman); and Department of Internal Medicine, Mount Sinai Medical Center, Miami, Florida (Dr Rodriguez-Escudero).
authors.forename: Quinn R
authors.initials: QR
authors.lastname: Pack
authors.forename: Ray W
authors.initials: RW
authors.lastname: Squires
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lichtman
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodriguez-Escudero
authors.forename: Victoria N
authors.initials: VN
authors.lastname: Zysek
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
mesh_terms: D000072038:Cardiac Rehabilitation; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014481:United States