January 14, 2020
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Few Medicare beneficiaries eligible for cardiac rehabilitation participate

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Matthew D. Ritchey

Only one-fourth of Medicare beneficiaries eligible for cardiac rehabilitation after a qualifying CV event underwent it, according to research published in Circulation.

This percentage falls short of the participation goal of at least 70% by 2022 set by the Million Hearts Cardiac Rehabilitation Collaborative.

Researchers found that among 366,103 cardiac rehabilitation-eligible Medicare beneficiaries, 24.4% participated in cardiac rehabilitation, of which 24.3% initiated within 21 days of the qualifying event and 26.9% completed rehabilitation, defined as attending at least 36 sessions.

Moreover, researchers observed that participation was:

  • lower among women compared with men (18.9% vs. 28.6%; adjusted prevalence ratio [aPR] = 0.91; 95% CI, 0.9-0.93);
  • lower among Hispanic patients compared with non-Hispanic white patients (13.2% vs. 25.8%; aPR = 0.63; 95% CI, 0.61-0.66);
  • lower among non-Hispanic black patients compared with non-Hispanic white patients (13.6% vs. 25.8%; aPR = 0.7; 95% CI, 0.67-0.72);
  • varied by hospital referral region and census division (range, 18.6% [East South Central] to 39.1% [West North Central]); and
  • varied by qualifying event type (range, 7.1% [acute MI without procedure] to 55.3% [CABG only]).

Strong evidence

“Despite cardiac rehabilitation having strong evidence demonstrating its lifesaving and life-enhancing benefit and Medicare Part B including coverage for it, this study found that the use of cardiac rehabilitation remains low among Medicare beneficiaries,” Matthew D. Ritchey, PT, DPT, OCS, MPH, researcher at the CDC’s division for heart disease and stroke prevention, told Healio. “In particular, cardiac rehabilitation use was lowest among women, beneficiaries aged 85 years and older, and nonwhite racial/ethnic groups. Its use also varied considerably based on where the beneficiaries lived and what qualified them for receiving cardiac rehabilitation. For example, participation in cardiac rehabilitation was lowest in the southeastern U.S. and Appalachia. Also, those who had a procedure performed, like coronary bypass surgery, were much more likely to use cardiac rehabilitation that those who had a heart attack and did not have a procedure performed.”

Researchers assessed Medicare fee-for-service beneficiaries eligible for cardiac rehabilitation in 2016 using measures of beneficiary characteristics, geography and qualifying event type (MI hospitalization, CABG, heart valve repair/replacement, PCI or transplant). Investigators analyzed cardiac rehabilitation participation, initiation and completion through 2017 with the aim of identifying demographics and geographic regions most at risk for service underutilization.

“A wealth of guidance exists that identifies the evidence-based strategies that can be used to increase cardiac rehabilitation use. However, they are not being widely and systematically implemented,” Ritchey said in an interview. “To support clinicians, hospitals and cardiac rehabilitation programs, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) teamed up with the Million Hearts initiative to highlight strategies that have been effectively used throughout the country in the Million Hearts/AACVPR Cardiac Rehabilitation Change Package.”

The Million Hearts collaborative

“The findings in this study are being used to track progress towards reaching the Million Hearts Cardiac Rehabilitation Collaborative’s goal of increasing cardiac rehabilitation participation in the United States to 70% or higher by 2022,” Ritchey told Healio. “The Million Hearts Cardiac Rehabilitation Collaborative includes over 400 representatives from organizations, agencies, institutions and clinics who are devoted to maximizing the health of people who have had a heart attack or other heart-related event or surgery.” – by Scott Buzby

Disclosures: The authors report no relevant financial disclosures.