Significant improvements have been demonstrated in CAD risk factors, functional capacity, vas- cular conditioning, and psychosocial well-being, all of which likely contribute to the robust effects of CR on overall clinical Among Medicare beneficiaries who have undergone CABG, patients are covered for up to 36 sessions of CR over the course of 1 year after the incident surgical hospitalization; other medical payers offer similar coverage plans. Despite the wealth of evidence and the presence of insurance coverage, CR use patterns remain poor nationwide.329 333 In an analysis of Medicare claims data, only 31% of CABG patients received at least 1 session of CR, and there was considerable geo- graphic heterogeneity in CR use patterns.333 One of the key barriers to CR use is the process of refer- ral to CR.327 Even among hospitals using the AHA Get With The Guidelines program, only 56% of eligible patients were referred to CR.332 Clearly, improving referral patterns to CR programs is a key area in need of greater focus.331 Recognizing Kulik et al Secondary Prevention After CABG 945 the importance of CR and the poor referral patterns to CR, the AHA and ACC, in collaboration with the American Association of Cardiac and Pulmonary Rehabilitation, have released performance measures for CR referral.327 Although CR referral rates are currently low, newly devel- oped referral strategies hold great promise to overcome this In a randomized trial of 2635 patients with CAD admitted to 11 different hospitals, a referral process that con- sisted of a combination of CR liaisons and an automated refer- ral system resulted in 85.8% of patients being referred to CR and 73.5% being enrolled in CR compared with 32.2% and 29.0%, respectively, in the control group.337 In addition, strat- egies such as educational interventions335 and early appoint- ments and start dates338 340 have been shown to improve CR referral and use patterns. 