Tools to Promote Cardiac Rehabilitation Utilization

  1. Online course for acute cardiac healthcare providers on how to educate inpatients about cardiac rehabilitation and encourage them to participate (English):

This activity is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Canadian Cardiovascular Society. You may claim a maximum of 0.5 hours (credits are automatically calculated). These credits are also recognized by the AMA, among other bodies.

Link to course in French:
Link to course in Portuguese:
Link to course in Spanish:
A Chinese language version is also available: (code: xzkf999)

Please contact for more information on the translations or for any questions regarding this course.

Evidence supporting this free, open-access course can be found here: and here:

2. Patients can complete the Cardiac Rehabilitation Barriers Scale (CRBS) online, and receive suggested mitigation strategies specific to their top barriers. These can also be shared with cardiac rehab programs, who can support patients to overcome their barriers, and hence fully engage and reap the benefits of cardiac rehab:

3. Our review of CR quality indicators, where in Table 1 sets with utilization indicators are denoted: Moghei, M., Oh, P., Chessex, C., & Grace, S.L(2019). Cardiac rehabilitation quality improvement: A narrative review. Journal of Cardiopulmonary Rehabilitation and Prevention;39(4):226-234

and our narrative review on CR utilization globally, and what can be done about it:
Grace, S.L. Kotseva, K., & Whooley, M.A. (2021). Cardiac rehabilitation: Under-utilized globally. Current Cardiology Reports; 23(9):118.

4. UK’s NICE guidance for myocardial infarction includes a section on recommendations “encouraging people to attend” cardiac rehab. See:

5. Some great practical resources from the U.S.:

6. Our lab updated the Cochrane review on interventions to promote cardiac rehabilitation (CR) utilization ( ICCPR and CACPR developed a joint policy statement to translate the evidence into clinical practice recommendations. See: Santiago, C.S.P., Beckie, T., Sarrafzadegan, N., Babu, A., Baidya, S., Buckley, J., Chen, S-Y., Gagliardi, A., Heine, M., Khiong, J.S., Mola, A., Radi, B., Supervia, M., Trani, M.R., Varnfield, M., Abreu, A., Sawdon, J., Moffatt, P.D., & Grace, S.L. (ePub; Nov 22, 2019). Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation Position Statement. JCRP.

We contacted corresponding authors of included, successful interventions as well as of ongoing interventions to ask if they were willing to share their intervention tools with the broader community. Those provided are listed below.

For your information, we have also collated some other interventions from our lab in case they are of interest, or others would like to undertake adequately-powered trials to test them (see bottom).

Published, successful trials included in review:

1. Benz-Scott L, Gravely S, Sexton TR, Brzostek S, Brown DL. Examining the effect of a patient navigation intervention on outpatient cardiac rehabilitation awareness and enrollment. Journal of Cardiopulmonary Rehabilitation and Prevention 2013;33(5):281-91. Weblink:


a) Navigator Scripts (please note postcard not available)

2. Lynggaard V, Nielsen CV, Zwisler AD, Taylor RS, May O. The patient education - learning and coping strategies - improves adherence in cardiac rehabilitation (LC-REHAB): a randomised controlled trial. International Journal of Cardiology 2017; June 1;236: 65-70. Weblink:


a) protocol including detailed description of intervention. Weblink:

b) Manual for patient education re: chronic disease (only available in Danish language): Hinrichsen EK. Learning and Coping Education. Patient education on the participants' grounds. Experienced and professional knowledge hand-in-hand. 2nd ed. Aarhus: DEFACTUM, Central Denmark Region; 2017 - can be purchased at:

3. LaValley GA, Szalai H, Pack QR, Storer A. A telephone intervention to improve patient return rates in cardiac rehabilitation: a pilot study. AACVPR 32nd annual meeting scientific abstract presentations. JCRP 2017;S209.


a) semi-structured script

b) Guide on how to focus the communication based on patients’ stage of change (transtheoretical model)

c) Risk stratification tool for non-adherence to cardiac rehab

On-going trial at time of last Cochrane update:

1. Ivers N, Schwalm JD, Witterman HO, Presseau J, Taljaard M, et al. Interventions supporting long-term adherence and decreasing cardiovascular events (ISLAND): pragmatic randomized trial protocol. American Heart Journal 2017;190:64-75. Weblink: 

Trial results currently under review in BMJ: successfully increased CR utilization.


a) Month 2 booklet to patients

b) Month 5 booklet to patients

c) Month 11 booklet to patients

d) Letters (patient, doctor) and CR Referral form

2. Gaalema D. Increasing Cardiac Rehabilitation Participation Among Medicaid Enrollees. Clinical Trials 2014; NCT02172820.Weblink:


a) how to incorporate motivational and financial incentives into CR

b) synopsis of experience incorporating incentives into program

Under-powered randomized trials:

1. Ali-Faisal SF, Scott LB, Johnston L, Grace SL. Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: A randomised controlled pilot trial. BMJ Open. 2016;6(3):e010214. doi:10.1136/bmjopen-2015-010214. Weblink:


a) Patient discussion documentation form (bedside, and 2 weeks post-discharge)

b) Patient pre-discharge contract

c) CR information pamphlet

d) Referral intervention script

2. Grace SL, Evindar A, Brooks D, Jaglal S, Abramson BL, Nolan R. Increasing patient-initiation of cardiac rehabilitation referral in female percutaneous coronary intervention patients. Can J Cardiovasc Nurs. 2005;15(1):23-27. Weblink:


a) List of intervention components

b) Bedside discussion re: CR (script)

c) motivational letter signed by physician

d) patient pamphlet about CR

e) Get Well Soon Card Text (mailed home after discharge)

f) Get Well Soon Card Text (for re-referral closer to home)

g) Post-Discharge Telephone Call Script

h) 2 Weeks Post-Discharge Telephone Call Script

No Randomized Evidence:

1. Pourhabib S, Kentner AC, Grace SL. The impact of patient-healthcare provider discussions on enrollment in cardiovascular rehabilitation. J Rehabil Med. 2014;46(9):924-931. doi:10.2340/16501977-1852. Weblink:

Pourhabib S, Chessex C, Murray J, Grace SL. Elements of patient-health-care provider communication related to cardiovascular rehabilitation referral. J Health Psychol. 2016;21(4):468-482. doi:10.1177/1359105314529319. Weblink:


a) inpatient motivational letter

2. Calouro M. Preparing patients at the bedside for their Cardiac Rehab journey. University Health Network Cardiovascular Prevention and Rehabilitation program. March, 2016


a) Flyer for patients about being referred to CR

b) Frequently asked questions about CR by patients with answers

3. Santiago Pio, C., & Grace, S.L. Cardiac inpatient healthcare provider handout with key points for bedside cardiac rehabilitation discussion with patients

Tool: Key points handout

Online course for healthcare providers to follow.