title: Cardiac rehabilitation wait times and relation to patient outcomes.
abstract: BACKGROUND
  Most cardiac rehabilitation (CR) associations have published guidelines recommending timely and early access.
  
  
  OBJECTIVE
  To review the effects of early CR initiation on patient outcomes, and to describe the wait times associated with positive outcomes.
  
  
  METHODS
  Studies were identified via a limited systematic search on key resource databases, including MEDLINE, EMBASE, and CINAHL. A focused Internet search was conducted with a concentrated grey literature search for evidence reports.
  
  
  METHODS
  Studies which enrolled adult cardiac patients who were eligible to participate in a CR program, based on CR guidelines, were considered.
  
  
  METHODS
  Methodological filters limited retrieval for articles published between January 1, 2002-March 4, 2013. Two reviewers screened references which were identified by the search strategy by examining the titles and abstracts. If the abstract identified the appropriate patient group, and addressed CR wait times, the full article was obtained for inclusion consideration. Ten articles were included for review. Results were extracted from included studies, and results were synthesized narratively.
  
  
  RESULTS
  Early access was generally shown to be safe, and to have positive effects in terms of cardiac function and patient enrollment. Positive effects on functional capacity were shown with CR initiation within 3 months from an index event. Effects on quality of life were null in the long-term. Wait times ranged from 8.5-127.0 days. Seventeen days may be the optimal wait time to balance benefit with risk.
  
  
  CONCLUSIONS
  Timely access to cardiac rehab can achieve greater patient enrolment. Research on the effects of early access on heart healthy behaviors and mental health are needed. Evidence-based recommendations for wait times should be formulated by indication.
  
  
  CONCLUSIONS
  Delays to intake should be minimized, and wait times shortened significantly, so that patients can reap the maximum benefits from CR participation.
authors.affiliation: York University, Faculty of Health, School of Kinesiology and Health ScienceToronto, ON, Canada - sgrace@yorku.ca.
authors.forename: Z C
authors.initials: ZC
authors.lastname: Collins
authors.forename: N
authors.initials: N
authors.lastname: Suskin
authors.forename: S
authors.initials: S
authors.lastname: Aggarwal
authors.forename: S L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000072038:Cardiac Rehabilitation; D003695:Delivery of Health Care / Q000592:standards*; D004185:Disability Evaluation; D006801:Humans; D011788:Quality of Life; D013997:Time Factors