Degree Name

Doctor of Nursing Practice (DNP)

Document Type

Project Paper


Zvart Onanian School of Nursing



Date of Original Version



Background: Heart disease is the leading cause of death in the United States (US), killing 610,000 Americans each year (CDC, 2017). Cardiac rehabilitation (CR) is a Class I recommendation by the American Heart Association and American College of Cardiology Foundation for patients after coronary artery (Thomas et al., 2018). Completing a 12-week cardiac rehabilitation program after coronary revascularization can reduce all-cause mortality by 20% to 50% (Sandesara et al. 2015). Despite the proven benefits of CR, only 14-35% of heart attack survivors attend CR (Balady et al. 2011; Ades, et al., 2017; AHA, 2017).

Purpose/Specific Aims: There is a gap in the literature on the best approach to improve referrals. The Million Hearts Initiative was created by the CDC with a goal to increase CR participation from 20-30% to 70%. This quality improvement project aims to implement evidence-based interventions to increase referral rates to CR to over 70%.

Methods: Multi-level interventions including the creation of a multidisciplinary team, leveraging the electronic medical record (EMR), automating CR discharge instructions, and 1:1 advanced practice provider education. Documentation was standardized to address NCDR requirements.

Results:There was a statistically significant increase in patient referrals of 32.8% (p< 0.01, 95% CI 23.57% – 41.22%) from Quarter 4 2021 to Quarter 4 2022.

Conclusion: Cardiac rehabilitation is an underutilized resource after coronary artery stenting. Leveraging the EMR and providing 1:1 education to the discharging advanced practice providers was shown to have a statistically significant improvement on patient referral to CR.