AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and

AACVPR Outpatient Cardiac Rehabilitation Registry:

Definitions and Comments for Selected Data Elements

Updated May 2022

To ensure consistency in the data entered, definitions of several of the data elements in the AACVPR

Outpatient Cardiac Rehabilitation Registry have been standardized. All data entered must conform to

these particular definitions. When entering data, please also note the following:

1. It is not necessary to enter data in every field. Enter as much information as your resources

allow and protocols define. For the functional and psychosocial assessments, choose at least

one outcome to measure and report.

2. If you do not have data for a value, leave the field blank.

3. A zero means zero. Do not enter a zero into a field unless the value is truly zero.

4. For some clinical and functional assessments, be sure to select the appropriate units, e.g.,

feet/meters or pounds/kilograms, for the value you are reporting.

Regarding the functional, dietary and psychosocial tools, it is not necessary to use all the tools displayed.

Choose one or more tools that are appropriate for your patient population and that provide enough

information about the patient in order to generate a comprehensive rehabilitation treatment plan. A

basic assessment “toolkit” should include a depression screening tool, a dietary assessment tool, and a

health-related quality of life instrument. It also is not necessary to use any of the supported tools;

however, scores from non-supported tools will not be able to be reported in the registry.

For additional resources and for links to assessments and tools, please visit the Registry User Resource

Page here: https://aacvpr.org/registry-resources

The data elements are listed in the order they may be encountered while moving through the

patient record.

Patient Demographics

Hospital Medical

Record ID

Your institution’s medical record number for the patient. This is used to help you

correctly identify the patient’s registry record.

Last Name

Enter the patient’s last name. This is used to help you correctly identify the patient’s

registry record.

DOB

Enter the patient’s date of birth (MM/DD/YYYY)

Sex

Select the patient’s sex.

Race

Enter the patient’s primary identified race.

Hispanic/Latino

Ethnicity

Select whether the patient is of Hispanic/Latino ethnicity

Zip Code

Enter the zip code of the patient’s primary residence (Either 5 digits or Zip+4)

Highest Level of

Education

Select the option that best describes the patient’s highest educational level attained

Health Insurance Plan

Enter all health care insurer(s) for the patient. Select one as a primary insurance and

if patient has secondary insurance, also add into the field

Session Copay

Enter a per session copay amount, if any, the patient pays for participation in CR. If

there is no copay ($0 copay), please enter 0 into the field. If the copay is unknown,

please leave the field blank.

Medical History

Admission

Event

Enter the diagnoses or procedures that prompted the referral to CR. Enter all that

apply and select a diagnosis/procedure as the primary diagnosis.

For example, if the patient was admitted for a non-ST elevation MI and

subsequently had angioplasty and coronary stenting, enter “NSTEMI” and “PCI”

as the diagnosis/procedure. NSTEMI would be the primary event, followed by

PCI.

Also enter the date of the hospital admission. For patients who are referred to CR with

stable exertional angina or heart failure and who were NOT hospitalized, enter the date

of the physician consult that prompted the referral.

Risk factors

Select the appropriate option to note the presence or absence of hypertension,

hyperlipidemia, and diabetes mellitus/impaired glucose metabolism as risk

factors. Select the risk factor as present even if the risk factor is controlled with

medications.

Significant past

cardiovascular history

Select any factors that are in the patient’s past medical history but are not the

primary reason(s) for CR entry.

Comorbidities

Select any comorbid conditions for which the patient is currently being treated.

past history of cancer that is in remission or has been surgically removed

would not

be included.

Heart Failure Status

Select the type of diagnosed heart failure from the list. If heart failure is not

diagnosed, select “Not applicable”.

Program Fields

Referral date

Enter the date the referral document was signed by a physician. For patients

referred

from an inpatient care team, this may be the date of the discharge

orders. If the

patient does not eventually enroll in the program, select “No” for

the Enrolled field

and enter the primary reason for non-enrollment.

Enrollment date

Enter the date of the patient’s first billable exercise session. A billable session

would

use either the 93797 or 93798 code. An orientation session without

exercise would not

meet this criterion.

AACVPR Risk

Category

Select the patient’s risk category based on AACVPR Guidelines for Risk

Stratification

Prescribed

Sessions

Enter the number of prescribed sessions for the patient.

Justification for

number of

prescribed

exercise

sessions

Select the option that best describes how the number of prescribed exercise

sessions

was determined for the patient.

For example, if the patient’s health insurance limits the number of outpatient

sessions to 12, select “Insurance.” If your program’s risk stratification

protocol

determines the patient should have 24 sessions, select the “Risk

stratification” option.

If it is your program’s protocol to prescribe 36 sessions

for all patients, select the

“Protocol” option.

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

Intensive Cardiac Rehab

Usage - NEW

If the patient is currently participating in one of the three currently approved

cardiac rehab programs, please indicate the program in this field. The options are:

 Ornish

 Pritikin

Benson-Henry

Vaccination Status -

Influenza

Has the patient had a current influenza vaccination in the past year? Select the

appropriate option.

Vaccination Status –

Pneumococcal

Has the patient had a pneumococcal vaccination in their lifetime? Select the

appropriate option.

Completion status

The patient is defined as having completed CR when he/she has undergone a final,

formal discharge assessment session and updated treatment plan. If neither of

these

criteria is met, the patient has not completed CR and the primary reason for

non-

completion should be entered.

Program discharge date

Enter the date of the last billed Phase 2 exercise session or discharge

assessment

session.

# of sessions completed

Enter the number of billed outpatient CR exercise sessions the patient

completed.

# ECG sessions

Enter the number of completed sessions that were ECG-monitored

sessions.

Non-Center Sessions

Fields - NEW

Enter the number of cardiac rehab sessions that were not performed in the CR center

but were still under the aegis of the CR program, eg, in tele-rehab models, where the

patient is being monitored/surveilled while exercising. There will be one field for

billable sessions and one field for non-billable sessions.

Number of billable non-center sessions:

Number of non-billable non-center sessions:

The number of sessions that were billed should be entered into the “Number of Non-

Center Billable Sessions” field.

The number of sessions that were not billed or were unable to be billed should be

entered into the “Number of Non-Center Non-Billable Sessions” field.

Primary Source of

Communication for

Non-Center Sessions -

NEW

Please select the primary (i.e. most commonly used) source of communication for all

non-center sessions.

Follow-up Date

Enter the date the patient received a follow-up session or contact.

Follow-up method

Select the type of follow-up assessment performed.

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

Lipids/Glucose

Pre/post lab values

and dates (lipids,

fasting blood glucose,

hemoglobin A1C)

Use the values from the most recent test date you can find in the medical record

that

is no earlier than one (1) year prior to the assessment date. Do not use values

that

are more than one year old at the time of the assessment.

For example, if the patient’s enrollment date is in November and he/she had lipid

results from three months earlier (in August), use these values. If there are no entry

values within the one-year time limit, leave the fields blank. If the patient’s

discharge

was subsequently in January but he/she did not have any repeat lipid

tests done, DO

NOT repeat the previous values. Instead, leave the discharge fields

blank.

If the patient is scheduled to have labs done as part of his/her admission and/or

discharge evaluation, you can use those results in the corresponding sections. If the

lipids, glucose, or A1C value was obtained by point-of-care methods such as a

portable

glucometer or Cholestech machine, check the POC (point-of-care) option.

Blood Glucose &

Hemoglobin Fields

Enter the date of the most recent fasting blood glucose, along with the fasting

blood glucose value, hemoglobin A1C date, hemoglobin A1C value if the patient has

a diagnosis of diabetes. Estimated Average Glucose will be calculated based on the

A1C values entered.

Blood Pressure/Dietary Fields

Blood pressure

Use a resting blood pressure, either one prior to starting exercise or one after

exercise. If the blood pressure is elevated, it is appropriate to check it again to

confirm that the elevated blood pressure is not just a transient event and then use

the average of 2 BP’s over a 5 minute period as the resting BP for the measure. Use

AHA guidelines for proper BP measurement and determination of cuff size.

Blood Pressure: Test

Not Completed

Please check this box for the following conditions where a standard blood pressure

measurement is not feasible or unsafe: Blood pressure measurement in patients

with

a left ventricular assist device (LVAD) does not produce a systolic and diastolic

blood

pressure, only a mean pressure. Therefore patients who have an LVAD should

not be

included in the measure denominator or numerator results. Medical or

surgical

contraindications to blood pressure measurement could include bilateral

lymphedema, bilateral mastectomy, upper extremity amputation, bilateral upper

extremity thromboembolism, or other contraindications as determined by the

patient’s healthcare provider. Checking this box will exclude patients from the

Program Certification Performance Measures calculations. For more information on

the Performance Measures, visit the Program Certification Resource Page here.

Diet Habit Survey

Enter the score for the Diet Habit Survey instrument.

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

Rate Your Plate –

Heart

Enter the score for the Rate Your Plate – Heart assessment instrument.

MEDFICTS

Enter the score for the MEDFICT dietary assessment instrument.

Block Fat Screener

Enter the score for the Block Fat Screener dietary assessment instrument.

Picture Your Plate

(PYP) - NEW

Enter the score for the Picture Your Plate (PYP) dietary assessment instrument.

Nutrition Counseling -

NEW

Please indicate if the patient has interacted with a registered dietitian over the course of

their participation in rehabilitation.

VioScreen Clinical

(Nutrascreen) - NEW

Please enter in the scores for the VioScreen Clinical (Nutrascreen) Assessment. Scores

collected: HEI, fruit cups, vegetable cups, sat fat (% of total energy), total fiber (grams).

Medication/Tobacco Fields

Tobacco Cessation

Intervention Options

Tobacco Cessation Counseling: Brief tobacco cessation counseling at program

entry. If the patient is not willing to make a quit attempt, intervention should be

aimed at helping the patient improve their readiness for an eventual quit attempt.

Tobacco cessation pharmacotherapy: Medication may be provided to patients

who

are not yet ready to quit, but who are ready to reduce to quit.

Referral to specialist: Referral to a tobacco treatment program or specialist

outside

of the CR program

Tobacco Intervention Not Indicated: Documentation of a medical reason for not

receiving tobacco cessation intervention or tobacco relapse prevention

intervention

(e.g. limited life expectancy).

Tobacco Type: - NEW

Please select the primary type of tobacco used by the patient from the list below:

 Cigarette

 Pipe

 Cigar

 Electronic cigarette

 Chewing Tobacco

 Hookah

Packs per day will be tracked for cigarette use. All other tobacco types will be

tracked by the number of days per month the patient uses the tobacco product.

Quit Year (Intake) -

NEW

Please enter the year (YYYY) that the patient quit the primary form of tobacco.

Quit Date (Discharge

& Follow-Up) - NEW

Please enter the date (MM/DD/YYYY) that the patient quit using tobacco.

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

Tobacco use status

(Intake)

The options for Tobacco Use Status within the registry at intake:



Never Smoker



Current (< one month)



Recent (1—6 Months)



Former (>6 Months)



Status Unknown

Tobacco use tracking should include cigarettes, cigars, cigarillos, chew tobacco, and

e-cigarettes.

Tobacco Status –

Discharge and Follow-

Up - NEW

Please select the patient’s tobacco use status at discharge or follow-up. If the patient

has used tobacco products in the past but has not used tobacco products within the

past seven (7) days, enter “Abstaining.” If the patient has used tobacco products within

the past seven (7) days, enter “Not Abstaining. If they have never smoked, select

“never smoker”. If you are unsure of the status, select “unknown.”

Medication

prescribed

Has the medication (Aspirin, beta-antagonist, ACE inhibitor or receptor blocker,

statin, PCSK9 inhibitors) been prescribed to the patient? If so, check the “Yes” option;

if not, check the “No” option. If the medication was not prescribed because of a

contraindication – the patient had negative side effects or there was another

medical reason for not prescribing the medication – select the “No - Exception”

option. You will be prompted to enter a reason for the exception. If the reason for

the patient not being prescribed the medication is unknown or if it is not clear that

the patient has been prescribed the medication, select the “Unknown” option.

NOTE: For Statin/Prescribed, if the patient is prescribed a statin, select the

appropriate

“intensity” from the option list. Refer to the “Resource for Statin Therapy” document

for details.

Medication

adherence

Is the patient adhering correctly to the medication prescription? Select the “Yes”

option if the patient is taking the medication according to the prescription;

otherwise,

select the “No” option. If the patient is not taking the prescribed

medication because

of intolerance or side effects, select the “No - Exception”

option. You will be prompted

to enter a reason for the non- adherence. If it is not

known why the patient is not

taking the prescribed medication, select the

“Unknown” option.

Anthropomorphic Fields

Waist circumference

(in)

Measure the waist circumference using the NIH criteria, i.e., a horizontal measurement

at the highest point on the iliac crest, preferably using reliable instruments such as a

Gulick II or MyoTape tape measure. Measure to the nearest quarter inch.

Weight

Weigh the patient prior to exercise without shoes and while wearing his/her typical or

usual exercise clothes. Record weight to the nearest tenth of a pound or kilogram if

using a digital scale, to the nearest quarter pound if using a balance beam scale. The

scale should be placed on a solid, level surface. Select the units used for measurement

(pounds or kilograms).

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

Height

Measure the patient’s height in stocking feet to the nearest quarter inch or whole

centimeter. Have the patient stand erect with the heels, buttocks, back of shoulders,

and back of head against the vertical scale. With the patient holding their breath, bring

the horizontal bar into contact with the highest point on the head. Select the units used

for measurement (inches or centimeters).

BMI

The BMI will be calculated automatically based on weight and height information

entered for the patient. BMI is calculated as mass divided by height squared.

Metabolic Syndrome

This field is calculated. Metabolic Syndrome is present if the patient has 3 or more of

the following clinical characteristic:

1) Triglycerides >= 150mg/dl;

2) HDL < 40 mg/dl (male), <50 mg/dl (female)

3) Central adiposity (waist circumference >35 (female), >40 (male)

4) BP>=130/>=85

5) Fasting Glucose >=110 mg/dl

For more information, visit the NIH website here: https://www.nhlbi.nih.gov/health-

topics/metabolic-syndrome

Functional Assessments

Functional Assessment:

Test Not Completed by

the Patient.

Check this box if the patient meets one of the conditions outlined below. Patients unable to

participate in a 6MWT, a graded exercise test, or unable to use an exercise device that can be

calibrated to estimate METs, due to physical,

cognitive, neurological, psychological, or safety

reasons or patients who have not

completed 4 weeks of CR. Checking this box will exclude

patient from Program

Certification Performance Measure calculations. For more

information on the Performance Measures, visit the Program Certification Resource

Page here.

Maximal METs

Use the estimated maximum MET value (to the nearest 0.1 METs) attained during a

graded, symptom- limited, maximal exercise test (GXT). Select what type of test was

performed (treadmill, bike, arm ergometer, other, or unknown).

Peak Exercise METs

For the intake value, use the estimated peak MET level attained during the third CR

exercise session. (Use the first two exercise sessions to tweak the exercise intensity.)

For the discharge value, use the estimated peak MET level attained during the

discharge exercise session or last exercise session. The estimated peak MET value

should be calculated using validated American College of Sports Medicine (ACSM)

equations.

6-minute walk distance

Report the distance attained during the 6-minute walk test in feet or meters. (Please

refer to “ATS Statement: Guidelines for the Six-Minute Walk Test” [Am J Respir Crit

Care Med. 2002; 166: 111-117. doi: 10.1164/rccm.166/1/111] or the Guidelines for

Cardiac Rehabilitation and Secondary Prevention Programs, Fourth Edition, 2004.)

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

6-minute cycle distance

Report distance pedaled in feet or meters for the 6-minute cycle test using an

appropriately calibrated Schwinn Airdyne Cycle Ergometer. (Miles attained on the

Airdyne x 5280 feet = feet pedaled.) (Please refer to “Validity and Reliability of the

North Carolina 6-Minute Cycle Test” [Verrill et al., J Cardiopulm Rehabil. 2006; 26: 224-

230.] for protocol.)

Exercise minutes/day

Enter the average number of minutes per day the patient engages in moderate

intensity exercise on days the patient exercises or is physically active. For the admission

value, the patient’s usual exercise behavior in the few weeks prior to the time of their

event should be used. For the discharge value, use the patient’s usual behavior one to

two weeks prior to discharge. Include minutes of exercise spent during CR. “Moderate”

intensity is defined as approximately 3–5 METs.

Exercise days/week

Enter the average number of days per week the patient engages in moderate intensity

exercise and/or physical activity. For the admission value, the patient’s usual exercise

behaviors in the few weeks prior to the time of their event should be used. For the

discharge value, use the patient’s usual behavior 1-2 weeks prior to discharge. Include

days exercised in CR.

Steps per day

For the intake value, enter the average number of steps per day the patient attains

during the first week of CR participation as measured by a pedometer calibrated

according to the manufacturer’s instructions. For the discharge value, enter the average

number of steps per day in the final week of CR participation.

Duke Activity Status

Index Score

Enter the Duke Activity Status Index Score.

DASI-METs

This value is derived from the DASI score. It is an estimate of the patient's peak MET

value.

MET minutes per week

(IPAQ)

Please enter in the International Physical Activity Questionnaire (IPAQ) MET minutes

per week.

Psychosocial Assessments

Psychosocial Section:

Test Cannot Be

Completed by the

Patient

Check this box if the patient is unable to complete the depression instruments for

the reasons described below. Checking this box will exclude the patient from the

Program Certification Performance Measure calculations. For more information

on the Performance Measures, visit the Program Certification Resource Page

here.



Inability to complete the depression instruments with reasonable

accommodations. Examples of Reasonable Accommodations:

• Staff member reads instrument instructions and

questions

to the patient

• Staff member enters patient’s responses to test items

to the

instrument



Presence of comprehension limitation that precludes completion of the

instrument



Lack of availability of the tool used by the CR program in a language

understood by the patient



Patient declines to complete the assessment.

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

CES-D Score

Enter in the total score for the Center for Epidemiologic Studies-Depression screening

too.

PHQ-9 Score

Enter the total score for the Patients Health Questionnaire-9 depression screening

tool.

BDI-2

Enter the total score for the Beck Depression Inventory-2 tool.

HADS

Enter the total score for the Hospital Anxiety and Depression Score tool.

Dartmouth COOP

Enter in the combined score of the 9 original subscales of the Dartmouth COOP tool.

2015 Copyright

MacNew

Enter in the scores for the MacNew tool. Scores collected: Emotional Scale Score,

Physical Scale Score, Social Scale Score, Global Scale Score

SF12

Enter in the scores for the Short Form-12 Physical Component Summary Score (PCS

Score) and the Mental Component Summary Score (MCS Score)

SF36

Enter in the scores for the Short Form-36 Physical Component Summary Score (PCS

Score) and the Mental Component Summary Score (MCS Score)

Ferrans & Powers QLI

Enter in the scores for the Ferrans & Powers Quality of Life Index Cardiac Health tool.

Scores collected: Health/Functioning Score, Social/Economic Score,

Psychosocial/Spiritual Score, Family Score, Global Score

PRFS

Enter in the scores for the Psychosocial Risk Factor Survey. Scores collected: PRFS

Depression, PRFS Anxiety, PRFS Hostility, PRFS Social Isolation, PRFS Total Distress.

EQ-5DL

Enter in the raw score for the EQ-5D as a 5-digit value, eg 11213. All 5 digits must be

entered.

VAS Scale

Enter the score from the EQ-5D Visual Analog Scale.

Heart Failure Assessments

LVEF

Enter the patient’s most recent resting LVEF as measured by resting echocardiogram,

nuclear study, or left heart catheterization procedure.

NYHA Class

Enter the patient’s New York Heart Association heart failure class.

KCCQ Test

Enter in the Kansas City Cardiomyopathy Questionnaire scores. Scores collected:

Physical Limitations Score, Symptoms Score, Stability Score, Self-Efficacy Score, Social

Score, Quality of Life Score, Functional Status Score, Clinical Summary Score.

Hospital Utilization

Hospital readmissions

and reasons for

readmissions

Enter all UNPLANNED hospital readmissions. DO NOT include planned cardiac

procedures such as angioplasties. Select the most pertinent reason for the patient’s

readmission to the hospital. Include readmissions that occur during the patient’s

participation in Phase 2 CR and those that occur during the period between the

patient’s discharge from Phase 2 and follow-up assessment.

AACVPR Outpatient Cardiac Rehabilitation Registry: Definitions and Comments for Selected Data Elements

Adverse events

Adverse events are medical events that require immediate cessation of exercise,

assessment, and intervention by CR staff and immediate transport to an

emergency

department. It is assumed that a physician will be contacted regarding

the patient’s

disposition and that the patient will be admitted to the hospital as a

result of the

event.

Unexpected events

Unexpected events are medically related events that require cessation of exercise

and

staff intervention and assessment. A physician may be contacted as part of the

disposition. The patient may or may not be referred to the emergency department,

depending on the situation/event.

Disposition

Select from “MD called,” “ED visit,” or “Hospital admission.” These are not mutually

exclusive, but graded in response. Depending on the severity of the event, you may

elect to only contact the patient’s physician. If more severe, the patient may be

taken

to the Emergency Department (ED). If the patient is admitted after being seen

in the

ED, select “Hospital admission.” In the latter two cases, it is assumed that the

patient’s

physician will be notified.

ED visits

Enter the date(s) and reason(s) for visits to an Emergency Department. These visits are

usually less than 1 day in duration.