Supervised exercise and electrocardiographic monitoring during cardiac rehabilitation. Impact on patient care.

PURPOSE To determine the frequency of medical problem detection during supervised cardiac rehabilitation exercise, and to assess its impact on patient care alteration. METHODS Six hundred sixty-six cardiac participants (388 in Phase II and 278 in Phase III) were studied during a 1-year period (1989-1990). The supervisory staff recorded all phone calls made to referring physicians regarding individual patient problems identified during exercise sessions including subsequent alteration in patient care. RESULTS Overall, 112 of 666 (17%) of the patients had problems detected that prompted calls to referring physicians. There was 0.009 call per patient exercise hour, compared to 0.002 call per patient exercise hour in the Phase II and Phase III patients, respectively, P = .0001. Although Phase II patients had a higher uncorrected arrhythmia call frequency compared to the Phase III patients, arrhythmia call frequency was higher in Phase III patients, when corrected for the number of monitored exercise hours (P = .02). Fifty-five percent of calls resulted in patient care alteration, and telemetry-related calls and nontelemetry-related calls resulted in a similar proportion of patient care alteration. Overall, 11% (73 of 666) of patients had alteration of their care, of which 4% (24 of 666) resulted from telemetry-related calls. Clinical variables between the patients with calls versus the patients with no calls demonstrated that the call group were older, and had a more frequent history of hypertension. CONCLUSION Medically supervised cardiac rehabilitation with and without telemetry monitoring detects problems that lead to alteration in medical care. Older patients have more problems detected. Medical problem detection may contribute to the beneficial impact of cardiac rehabilitation observed in randomized trials.