The TAKEheart Initiative

Aims

AHRQ's TAKEheart initiative seeks to increase participation in cardiac rehabilitation (CR) among eligible patients nationwide.

Key Components

TAKEheart promotes two proven strategies for increasing referral and enrollment in CR:

• Implementing automatic referral to make referral the default action through the electronic health record. Providers would have to actively "opt out" to prevent the referral from automatically moving forward.
• Ensuring care coordination for all patients who are referred for CR. Care coordinators begin to work with patients during their hospital stays or shortly after discharge, help educate patients about the benefits of CR, and help them enroll in CR programs.

Origins and Evolution

TAKEheart originated as a collaboration between AHRQ and CDC in response to the continuing underuse of CR in the U.S. by eligible patients. In March 2019, AHRQ launched the TAKEheart initiative to actively engage hospitals in implementing systematic automatic referral with care coordination processes. The initiative was designed to promote the use of strategies described in the Million Hearts^®/AACVPR Cardiac Rehabilitation Change Package (CRCP).

• Between 2021 and 2022, trainings were provided virtually to over 100 recruited TAKEheart Partner Hospitals. These expert-led, on-line trainings were supplemented with written, actionable, implementation guidance.
• CR champions and other experts—including TAKEheart coaches and CR patients—also met monthly in small groups to discuss the implementation challenges they were encountering.
• Lessons learned from the experiences of the Partner Hospitals helped coaches produce a revised, stand-alone set of training materials and resources that can be used independently by other hospitals for their own quality improvement journeys. Visit the training section to access these updated training materials.

In addition to its work with recruited Partner Hospitals, TAKEheart hosted a Learning Community  to allow a broader group of hospitals to share insights on topics of interest, including strategies for addressing low patient enrollment and completion rates, particularly among underserved patients.

• Over 850 hospitals participated in one or more sessions of the Learning Community that were held between April 2020 and November 2022.
• Session topics included practical ways to conduct CR and support patients during the COVID-19 pandemic and ways to address the needs of women, patients with heart failure, and other groups of people underrepresented in CR programs.
• Visit the Learning Community webinar page to access recordings of all webinars and related materials.

TAKEheart Today

Today, TAKEheart provides a rich array of training and informational resources, including:

• Training materials to permit hospitals to proceed at their own pace in implementing evidence-based strategies for increasing referrals and enrollment.
• Informational materials to help CR champions and other CR stakeholders raise awareness  and educate others about the benefits of patient participation in CR; the causes of continuing underuse of this valuable program; and the evidence for two key strategies for increasing CR participation.
• Peer-generated resources and knowledge for tackling a range of challenges commonly faced by CR programs. 
• Information about the continuing efforts of CDC and other partners to provide engagement opportunities and knowledge about new advances in CR delivery.

New Frontiers: Exploring Hybrid CR

The COVID-19 pandemic accelerated hospitals' use of audio/visual communication technology services for some components of CR. In response, TAKEheart formed a workgroup of experts and practitioners to learn more about rapidly evolving "hybrid CR" programs. In hybrid programs, some aspects of CR are delivered within the hospital outpatient setting and other aspects are delivered and supervised remotely. Visit the expanding CR capacity  component of TAKEheart's training to explore this exciting new option.