Fonarow and colleagues evaluated hospitals ranging from small to large in size, not-for-profit and profit-based institutions, from regions all throughout the country. While the hospitals were predominantly urban, two-thirds of them were teaching facilities and the remainder were community-based institutions. Researchers found that the type of treatment facility had very little, if any, effect on the referral rate.

This is the first study to analyze the frequency of referrals for heart failure patients since the American Heart Association updated its guidelines to include the recommendation that patients with stable heart failure be referred for cardiac rehabilitation. It is also the first study to evaluate the factors by which the necessity of rehabilitation was referred.


“Honestly, other than being mentioned in the guidelines as recommended, there have been no educational campaigns, no efforts from Medicare [or efforts by other organizations] to increase awareness,” Fonarow pointed out.

“We hope to highlight this surprising underutilization in this research,” he said. “There is a tremendous opportunity, and we hope to shine light on this by this publication. We hope that professional organizations and individual clinicians will find this interesting and want to be taking on improving [outcomes] for the patient population.”

Study limitations included the fact that the researcher did not evaluate results for every hospital in the U.S., which might make the findings of the study a little difficult to generalize. Additionally, the study did not evaluate subsequent outcomes for patients who were rehabilitated, and this leaves opportunity for inclusion in future studies.

Researchers were unable to evaluate educational level and socioeconomic status of the heart failure patients evaluated.

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