Inclusion Requirements

For Physicians, Nurse Practitioners, and Other Referrers: Inclusion Criteria

Indications and Referrals for the Cardiovascular Rehabilitation Program

Physician referral is required for consideration of participation in the Thunder Bay Regional Health Sciences Centre Cardiovascular Rehabilitation Program and the 12 Regional satellite sites across Northwestern Ontario. Please read the following to ensure your patient meets program criteria. Please note: referral is not an automatic acceptance into the program. Program staff will review each referral and accept or reject based on the criteria below.

In keeping with the Standards for the Provision of Cardiovascular Rehabilitation (2014), referrals are received for a variety of cardiovascular conditions from both internal and external partners. Standard 1.1.1 clearly outlines patients with diagnoses that are eligible to participate and receive CR services at our Hospital and the twelve (12) satellite programs across Northwestern Ontario.

The Cardiovascular Rehabilitation Program has determined the following inclusion/exclusion criteria and non-eligible referrals to accurately reflect the patient populations serviced and the partnerships within Northwestern Ontario and the University Health Network (UHN).

Inclusion Criteria

Over the age of 18 plus at least one (1) of the following procedures and/or diagnoses and within twelve (12) months of the referred event:

  • Diagnosed Acute Coronary Syndrome (ACS) with or without intervention
    • with recent hospitalization
    • Coronary Spasm with ACS and/or documented ST segment elevation
    • Spontaneous Coronary Artery Dissection
    • Medical management with documented Coronary Artery Disease (CAD)
  • Post-Percutaneous Coronary Intervention
  • Post-Coronary Artery Bypass Graft Surgery
  • Post Valve Repair/Replacement
    • including Trans-catheter Aortic Valve Implantation (TAVI)
  • Chronic Stable Angina
    • with no event
  • Post- Cardiac Transplant
  • Stable Chronic Heart Failure
  • Cardiomyopathy
    • Dilated, Hypertrophic, Hypertrophic Obstructive, Idiopathic, Ischemic, Restrictive
  • Pacemaker, Implantable Cardiac Defibrillator, Coronary Resynchronization Therapy
    • Not a single criteria; must have other indications for Cardiac Rehabilitation (e.g. Heart Failure, Cardiomyopathy)
  • Congenital Heart Disease (Adult Congenital Heart Disease)
  • Arrhythmias
    • Atrial flutter, atrial fibrillation
      • In the absence of other indications for CR, consider Cardiac Rehab Home Program
    • Postural Orthostatic Tachycardia Syndrome (in the absence of CAD)
    • Multiple cardiac risk factors with a diagnosis Diabetes Mellitus and with hemodynamically significant Coronary Artery Disease (blockages ≥60%) as documented through positive stress test, thallium stress and/or angioplasty
      • Consider short program with education focus
    • Multiple cardiac risk factors without a diagnosis Diabetes Mellitus and with hemodynamically significant Coronary Artery Disease (blockages ≥60%) as documented through positive stress test, thallium stress and/or angioplasty
      • Must have Three (3) or more documented risk factors to be eligible
      • Consider short program with education focus
  • Patients previously referred to CR who did not complete their program due to medical reasons (including a second procedure, for example Percutaneous Coronary intervention)
    • Eligible for direct program re-entry if re-referred <1 months of original referral
      • Duration of program is the remaining time in their initial program
    • No new admission if ˃12 months from date of original referral
      • A new referral will be required for participation
    • Aortic Aneurysm Repair
      • EVAR
    • Symptomatic Peripheral Vascular Disease (PVD)
      • Claudication
    • Peripheral Artery Stenting
    • Peripheral Artery Bypass

Exclusion Criteria Considerations

The following clinical situations are considerations for exclusion but may not be absolute exclusions as each situation is individual and may have the potential to be supported. Consideration of program options across the Health Sciences Centre and the twelve (12) satellite sites of the program should always be given including but not limited to education only.  When there is uncertainty about appropriateness at time of referral, consultation with the Site Medical Lead or Program manager is encouraged.

  • Patients who are unable to exercise safely and effectively due to a physical or cognitive impairment
    • Consider Education only with no Intake or GXT
  • High level visual impairment is a consideration for use of dedicated volunteer or essential care partner during exercise participation
  • High Level Falls Risk (as assessed via the Morse assessment)
    • Despite implementation of Universal Falls Precautions, it is unsafe for patient to participate
      • Consider Education only with no Intake or GXT
    • Untreated diagnosed mental health problem, such as schizophrenia, except depression or anxiety
    • Unstable Angina
    • Unstable Heart Failure
      • NYHA class 3/4 or 4/4
      • EF ≤20%
    • Unstable Atrial or Ventricular Arrhythmia not currently receiving treatment
    • Acute Pericarditis/Myocarditis
    • Non-cardiac diagnosis requiring acute treatment
      • Musculoskeletal, malignancy, pulmonary dysfunction
        • Refer to appropriate rehab
      • Non-compliance to program protocol on previous referral

Non-Eligible Referrals

  • Previous participation in a cardiac rehabilitation program without new diagnosis, hospitalization, and/or surgery
  • Less than Three (3) cardiac risk factors with no known CAD or DM such as:
    • Hypertension, Obesity, Sedentary behaviour, Hyperlipidemia, Smoking, Family History

In the event a patient has been referred to our Hospital’s Cardiovascular Rehabilitation Program and has been deemed non-eligible due to the exclusion criteria or not-eligible, a letter communicating this decision must be completed to close the circle of care. This letter is to be written to the referring physician by the program’s Navigator and a copy is saved within their chart.