Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients

Mohanad Albayyaa; Shiva Gollapally Krishna; Qamar Othman Abdullah; Ibrahim Mortada; Riham Dheyab; Abdul Qadeer; Carolina Colli Cruz; Jesús Gibran Hernández-Pérez; Omer Abdelgadir; David S Lopez; Hani Jneid; Bashar Al Hemyari

doi:10.1016/j.jaccas.2026.110346

Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients

Mohanad Albayyaa
, Shiva Gollapally Krishna
, Qamar Othman Abdullah
, Ibrahim Mortada
, Riham Dheyab
, Abdul Qadeer
, Carolina Colli Cruz
, Jesús Gibran Hernández-Pérez
, Omer Abdelgadir
, David S Lopez
, Hani Jneid
, Bashar Al Hemyari

University of Texas Medical Branch

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Cardiac rehabilitation (CR) is a guideline-recommended therapy that improves outcomes in cardiovascular disease, yet referral at hospital discharge remains suboptimal.

PROJECT RATIONALE: Variability in discharge workflows and inconsistent use of standardized referrals contributed to missed CR referrals among eligible patients.

PROJECT SUMMARY: We implemented an electronic health record (EHR)-based best practice advisory within the Epic EHR system to prompt CR referral or documentation of nonreferral reasons for guideline-eligible cardiovascular patients. A retrospective quality improvement study compared preimplementation (February 1, 2022-January 31, 2024) and postimplementation (February 1, 2024-January 31, 2026) cohorts (N = 21,294). Outcomes assessed included CR referral orders, documentation of referral activity, and CR-related activity. CR referral rates increased from 45.3% to 86.7% after best practice advisory implementation.

TAKE-HOME MESSAGES: EHR-based decision support improved CR referral rates among guideline-eligible patients by integrating referral prompts into discharge workflows. Continued optimization of provider engagement and workflow integration may further improve referral completion.

Original language	English (US)
Pages (from-to)	110346
Journal	JACC: Case Reports
Volume	31
Issue number	37
DOIs	https://doi.org/10.1016/j.jaccas.2026.110346
State	Published - Sep 16 2026

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Albayyaa, M., Krishna, S. G., Abdullah, Q. O., Mortada, I., Dheyab, R., Qadeer, A., Cruz, C. C., Hernández-Pérez, J. G., Abdelgadir, O., Lopez, D. S., Jneid, H., & Al Hemyari, B. (2026). Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients. JACC: Case Reports, 31(37), 110346. https://doi.org/10.1016/j.jaccas.2026.110346

Albayyaa, M, Krishna, SG, Abdullah, QO, Mortada, I, Dheyab, R, Qadeer, A, Cruz, CC, Hernández-Pérez, JG, Abdelgadir, O, Lopez, DS, Jneid, H & Al Hemyari, B 2026, 'Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients', JACC: Case Reports, vol. 31, no. 37, pp. 110346. https://doi.org/10.1016/j.jaccas.2026.110346

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title = "Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients",

abstract = "BACKGROUND: Cardiac rehabilitation (CR) is a guideline-recommended therapy that improves outcomes in cardiovascular disease, yet referral at hospital discharge remains suboptimal.PROJECT RATIONALE: Variability in discharge workflows and inconsistent use of standardized referrals contributed to missed CR referrals among eligible patients.PROJECT SUMMARY: We implemented an electronic health record (EHR)-based best practice advisory within the Epic EHR system to prompt CR referral or documentation of nonreferral reasons for guideline-eligible cardiovascular patients. A retrospective quality improvement study compared preimplementation (February 1, 2022-January 31, 2024) and postimplementation (February 1, 2024-January 31, 2026) cohorts (N = 21,294). Outcomes assessed included CR referral orders, documentation of referral activity, and CR-related activity. CR referral rates increased from 45.3\% to 86.7\% after best practice advisory implementation.TAKE-HOME MESSAGES: EHR-based decision support improved CR referral rates among guideline-eligible patients by integrating referral prompts into discharge workflows. Continued optimization of provider engagement and workflow integration may further improve referral completion.",

author = "Mohanad Albayyaa and Krishna, \{Shiva Gollapally\} and Abdullah, \{Qamar Othman\} and Ibrahim Mortada and Riham Dheyab and Abdul Qadeer and Cruz, \{Carolina Colli\} and Hern{\'a}ndez-P{\'e}rez, \{Jes{\'u}s Gibran\} and Omer Abdelgadir and Lopez, \{David S\} and Hani Jneid and \{Al Hemyari\}, Bashar",

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doi = "10.1016/j.jaccas.2026.110346",

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T1 - Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients

AU - Albayyaa, Mohanad

AU - Krishna, Shiva Gollapally

AU - Abdullah, Qamar Othman

AU - Mortada, Ibrahim

AU - Dheyab, Riham

AU - Qadeer, Abdul

AU - Cruz, Carolina Colli

AU - Hernández-Pérez, Jesús Gibran

AU - Abdelgadir, Omer

AU - Lopez, David S

AU - Jneid, Hani

AU - Al Hemyari, Bashar

PY - 2026/9/16

Y1 - 2026/9/16

N2 - BACKGROUND: Cardiac rehabilitation (CR) is a guideline-recommended therapy that improves outcomes in cardiovascular disease, yet referral at hospital discharge remains suboptimal.PROJECT RATIONALE: Variability in discharge workflows and inconsistent use of standardized referrals contributed to missed CR referrals among eligible patients.PROJECT SUMMARY: We implemented an electronic health record (EHR)-based best practice advisory within the Epic EHR system to prompt CR referral or documentation of nonreferral reasons for guideline-eligible cardiovascular patients. A retrospective quality improvement study compared preimplementation (February 1, 2022-January 31, 2024) and postimplementation (February 1, 2024-January 31, 2026) cohorts (N = 21,294). Outcomes assessed included CR referral orders, documentation of referral activity, and CR-related activity. CR referral rates increased from 45.3% to 86.7% after best practice advisory implementation.TAKE-HOME MESSAGES: EHR-based decision support improved CR referral rates among guideline-eligible patients by integrating referral prompts into discharge workflows. Continued optimization of provider engagement and workflow integration may further improve referral completion.

AB - BACKGROUND: Cardiac rehabilitation (CR) is a guideline-recommended therapy that improves outcomes in cardiovascular disease, yet referral at hospital discharge remains suboptimal.PROJECT RATIONALE: Variability in discharge workflows and inconsistent use of standardized referrals contributed to missed CR referrals among eligible patients.PROJECT SUMMARY: We implemented an electronic health record (EHR)-based best practice advisory within the Epic EHR system to prompt CR referral or documentation of nonreferral reasons for guideline-eligible cardiovascular patients. A retrospective quality improvement study compared preimplementation (February 1, 2022-January 31, 2024) and postimplementation (February 1, 2024-January 31, 2026) cohorts (N = 21,294). Outcomes assessed included CR referral orders, documentation of referral activity, and CR-related activity. CR referral rates increased from 45.3% to 86.7% after best practice advisory implementation.TAKE-HOME MESSAGES: EHR-based decision support improved CR referral rates among guideline-eligible patients by integrating referral prompts into discharge workflows. Continued optimization of provider engagement and workflow integration may further improve referral completion.

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DO - 10.1016/j.jaccas.2026.110346

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SP - 110346

JO - JACC: Case Reports

JF - JACC: Case Reports

IS - 37

ER -

Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients

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