Participation in Cardiac Rehabilitation Among Patients With Heart Failure

Abstract

Objectives We sought to determine: a) the proportion of patients with heart failure (HF) who participated in cardiac rehabilitation (CR); and b) patient characteristics associated with participation. Background CR is linked to reduced mortality and morbidity including improvements in cardiorespiratory fitness, psychosocial state, and quality of life in patients with HF. However, little is known about CR utilization among patients with HF. Methods A retrospective study was conducted using national data from the Centers for Medicare & Medicaid Services and the Veterans Health Administration (VA). We used primary discharge ICD-9 codes to identify patients hospitalized for HF from 2007–2011 then identified CR participation using CPT codes from claims data. Multivariate logistic regression was used to identify patient characteristics associated with CR participation. Results There were 66,710 Veterans and 243,208 Medicare beneficiaries hospitalized for HF and 1,554 (2.3%) and 6,280 (2.6%), respectively, who attended one or more sessions of outpatient CR. Among Medicare beneficiaries, men were more likely than women to participate in CR (3.7% vs. 1.8%; p<0.001), but there was no gender difference among Veterans (2.3% vs. 2.8%; p=0.40). Characteristics associated with participation in CR among both groups included younger age, white race, and history of ischemic heart disease. Conclusions Very few HF patients participated in CR with lower rates among those who were older, non-white, and female with a history of depression or other chronic medical conditions. Since Medicare has recently introduced coverage for CR in patients with systolic HF, we must increase efforts to improve CR participation, especially among these vulnerable groups.

Nationwide Survey of Multidisciplinary Care and Cardiac Rehabilitation for Patients With Heart Failure in Japan ― An Analysis of the AMED-CHF Study ―

“…12,17 At the level of the healthcare system, the low CR implementation rate has been reported to be related to financial constraints, distance, and transportation problems. 12,18 There have been few reports regarding the participation rate in outpatient CR among patients with HF globally. According to the Get With The Guidelines-Heart Failure registry involving >100,000 patients admitted with HF at 338 institutions in the USA, the rates of participation in outpatient CR were reported to be extremely low, with rates of 2.3% among veterans and 2.6% among beneficiaries of Medicare hospitalized for HF in the USA.…”

“…These observations suggest the vast underutilization of outpatient CR among patients with HF. 18 To improve this situation, the American College of Cardiology/American Heart Association recently revised the CR performance and quality measure set with 6 new performance measures and 3 new quality measures, including exercise training referral and enrollment for HF with reduced ejection fraction, and CR enrollment and adherence. 19 This new measurement set is expected to improve both the CR participation rate and outcomes.…”

Exploring patient experiences and perspectives of a heart failure telerehabilitation program: A mixed methods approach

“…27 While males predominate in the majority of published exercise-based rehabilitation studies in this population, 30 it is also commonly seen in clinical practice. 32 As our study focused on patient experiences and perspectives of a HF telerehabilitation program, future studies should explore other views including the patient's support person and clinicians involved in the delivery of telerehabilitation programs. In summary, participants in this HF telerehabilitation program reported high visual clarity and ease-of-use, but provided suggestions for further improvements.…”

Clinician — Treats, and Patient — Being Treated? Recent View on the Treatment Adherence in Coronary Heart Disease Setting

“…Авторы заключают, что не демогра-фические или клинические характеристики влияют на отказ от продолжения кардиореабилитации, но ключевыми являются психосоциальный статус и социальное окружение [3]. К подобным выводам пришли и Park LG, et al (2017) в отношении пациен-тов с сердечной недостаточностью [4].…”