Go to content

Researchers estimate the Ontario healthcare system could save $100 million if cardiac patients completed rehab


Patients who complete a cardiac rehabilitation program live longer, and cost the healthcare system up to $3,000 less annually compared with eligible patients who are either not referred, never show, or drop-out prematurely from the program. This, according to a new study published in the Mayo Clinic Proceedings.

Cardiac rehabilitation, or cardiac rehab, is a medically supervised program that helps improve cardiovascular health.

Among the 6,284 patients who were referred to rehab, 1,936 patients did not attend any scheduled visits and another 2,265 patients attended less than 67 per cent of scheduled visits – an attendance rate the researchers defined as the cut-off for cardiac rehab completion because of findings from previous studies linking poor rehab participation to worse outcomes including mortality and hospitalizations. 

“The two-thirds of patients referred to cardiac rehab who do not attend or drop out early represent a group of people who are at particularly high risk of dying and who are very costly to our healthcare system,” said Dr. David Alter, lead author and senior scientist, Toronto Rehab, University Health Network and Institute for Clinical Evaluative Sciences (ICES). “We need to focus heavily on improving those participation levels if we’re hoping to make strides in improving the cost-savings with cardiac rehab programs.”

The paper –“The relationship between cardiac rehabilitation participation and health service expenditures within a universal healthcare system” — focused on the opportunity for healthcare savings in a universal healthcare system such as in Canada, but can be applied to other jurisdictions with a public-payer system.

The researchers found that eligible patients for cardiac rehab who did complete a program cost the healthcare system $8 per day or nearly $3,000 less per year when compared with those who were not referred, did not show-up, or who dropped out. Approximately 30 per cent of eligible patients completed their cardiac rehab.

“We do not yet know how to engage and convert the non-participants into completers of cardiac rehab,” said Dr. Alter. “Up until now metrics around improving cardiac rehab participation levels have not been a focus. This study highlights the need to place a much greater focus on those who are dropping out and what else we can do within the healthcare system to better address these patients. This in turn will drive down costs and maximize heart disease survival.”

Previous studies have found there are an estimated 50,000 eligible patients for cardiac rehab per year in Ontario, and 25 per cent of those eligible patients are re-hospitalized while on a wait list for cardiac rehab.

“The effects of cardiac rehab for those who show up and stay are profound. We know that patients who complete cardiac rehab have the lowest mortality and lowest readmission rate. Our findings show that healthier patients have the potential of saving our healthcare system millions of dollars because healthy patients visit the emergency department less often, are hospitalized less frequently and to a lesser extent, have fewer doctor visits and lower drug costs,” adds Dr. Alter.

Funding for this study was provided through Dr. Alter’s Toronto Rehab Chair in Cardiac Research and the Heart & Stroke Mid-Career Investigator Award.

About Toronto Rehabilitation Institute
As the world-leading rehabilitation research centre, Toronto Rehabilitation Institute is developing practical solutions to prevent illness and accidents, restore function following a disabling event, and to enable people to continue to live in their own homes and communities as they age. It integrates innovative patient care, ground breaking research and diverse education to build healthier communities and advance the role of rehabilitation in the health system. Toronto Rehab, along with Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre and The Michener Institute of Education at UHN is a member of the University Health Network and is affiliated with the University of Toronto. www.uhn.ca

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario


Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996

Melissa McDermott
Senior Public Affairs Advisor
Toronto Rehab
University Health Network
416-597-3422 ext. 3524
[email protected]


Contributing ICES Scientists

Research Programs

Associated Sites

Read the Journal Article