Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative

Abstract

Background: Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization. Methods and Results: We identified Medicare fee-for-service beneficiaries who were CR eligible in 2016, and assessed CR participation (≥1 CR session attended), timely initiation (participation within 21 days of event), and completion (≥36 sessions attended) through 2017. Measures were assessed overall, by beneficiary characteristics and geography, and by primary CR-qualifying event type (acute myocardial infarction hospitalization; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant). Among 366 103 CR-eligible beneficiaries, 89 327 (24.4%) participated in CR, of whom 24.3% initiated within 21 days and 26.9% completed CR. Eligibility was highest in the East South Central Census Division (14.8 per 1000). Participation decreased with increasing age, was lower among women (18.9%) compared with men (28.6%; adjusted prevalence ratio: 0.91 [95% CI, 0.90–0.93]) was lower among Hispanics (13.2%) and non-Hispanic blacks (13.6%) compared with non-Hispanic whites (25.8%; adjusted prevalence ratio: 0.63 [0.61–0.66] and 0.70 [0.67–0.72], respectively), and varied by hospital referral region and Census Division (range: 18.6% [East South Central] to 39.1% [West North Central]) and by qualifying event type (range: 7.1% [acute myocardial infarction without procedure] to 55.3% [coronary artery bypass surgery only]). Timely initiation varied by geography and qualifying event type; completion varied by geography. Conclusions: Only 1 in 4 CR-eligible Medicare beneficiaries participated in CR and marked disparities were observed. Reinforcement of current effective strategies and development of new strategies will be critical to address the noted disparities and achieve the 70% participation goal.

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

“…Data collected about utilization of medicare benefits to analyse levels of participation, adherence, and completion (>36 sessions) of CR programs revealed higher participation among patients who underwent CABG and PCI after myocardial infraction (MI) when compared to MI alone, with men more than women and age groups of 74 to 85 years. Patients with multiple comorbidities (>5 comorbidities) after cardiac events presented with lower participation [52]. Implementation of CR programs at smaller tertiary hospitals and community centres, awareness about their efficacy, and beneficiaries through medicare would aid in higher participation after coronary revascularization procedures and improve functional parameters like aerobic capacity, physical activity, and quality of life.…”

Lifestyle interventions after ablation for atrial fibrillation: a systematic review

“…In other cardiac conditions in which the use of cardiac rehabilitation has demonstrated improved health outcomes, participation is low and geographical variability persists in participation. 39 However, hospitals have systematically integrated cardiac rehabilitation orders into their electronic medical record systems to help track the effects on patient outcomes and developed, for example, smart phone access to make adherence easier for patients. 40 Attention in the later years has also been on psychological factors because they can stimulate the autonomic nervous system, triggering the production of catecholamines, increased blood pressure, decreased plasma volume, contraction of coronary arteries, thrombocyte activity, coagulation and inflammation.…”

“…Despite findings that lifestyle interventions and risk factor modification are useful to improve a variety of cardiac patient outcomes, evidence has also shown that the routine use of these interventions is low. 39,52 Patients who had participated in one of the included RCTs in this review described in a qualitative study that participating in the intervention strengthened their belief in their physical capacity and survival; they needed support to move on; and that they had to regain confidence in their mental strength with support from professionals. 11 This review has illustrated knowledge gaps about the most effective lifestyle and risk factor management interventions for patients treated for AF ablation and the specific dose or frequency of these interventions.…”

Short-Term Exercise Progression of Cardiovascular Patients throughout Cardiac Rehabilitation: An Observational Study

“…An additional explanation can be found in the fact that non-procedure related secondary events as a reason for referral, are often characterized by low participation rates. The secondary events are typical the motivation behind referring HF patients to CR [ 40 ].…”