Despite the proven benefits of cardiac rehabilitation, only 20 to 30 percent of eligible patients actually participate. Researchers at the University of Vermont aimed to find out why.

According to an article published in Mayo Clinic Proceedings, two steps are necessary to substantially increase participation in cardiac rehabilitation programs: increasing systematic referral of eligible patients and optimizing enrollment and adherence of those referrals.

Participants of the Cardiac Rehabilitation Collaborative—a group of experts convened by Million Hearts—found that these methods have the potential to increase participation rates by at least 70 percent among eligible patients. If adopted nationwide, this could save 25,000 lives and reduce hospitalizations by 180,000 annually.

"While there are many reasons that individuals do not attend cardiac rehabilitation, including geographic availability of a program, the primary reason—and one that is modifiable—is that doctors and caregivers do not recommend it strongly enough," said Philip Ades, MD, Professor of Medicine at the University of Vermont's Larner College of Medicine and Associate Director of the Vermont Center on Behavior and Health.

Technology improvements could aid the process. If the hospital’s electronic discharge process required doctors to address cardiac rehabilitation and schedule a formal appointment for a week after the patient’s discharge, the likelihood of participation would rise, according to Ades.

The authors found that automatic electronic medical record referrals combined with the use of a liaison led to referral rates of 86 percent and participation rates of over 70 percent compared to 32 percent in controls who received neither intervention.

Participation rates would skyrocket, say Ades and his colleagues, if cardiac rehabilitation referral was considered to be a "quality of care indicator," like aspirin and statin use after a heart attack.