Only 1 in 4 Medicare patients participate in cardiac rehabilitation

January 14, 2020

DALLAS, Jan. 14, 2019 - Too few people covered by Medicare participated in outpatient cardiac rehabilitation after a heart attack or acute heart event or surgery, particularly women, the elderly and non-white patients, according to new research published today in the American Heart Association's journal Circulation: Cardiovascular Quality and Outcomes.

Every year, an estimated 1.3 million U.S. adults with heart disease may qualify for cardiac rehabilitation (this number does not include those with qualifying heart failure). [1]Outpatient cardiac rehabilitation has been shown to improve health outcomes among patients who have heart failure, have suffered heart attacks or have undergone a cardiac procedure such as coronary artery bypass surgery. This observational study measured participation rates and identified the populations and regions most at risk for suboptimal cardiac rehabilitation.

In the review of more than 366,000 patients covered by Medicare who were eligible for outpatient cardiac rehabilitation in 2016, researchers found:"Cardiac rehabilitation has strong evidence demonstrating its lifesaving and life-enhancing benefits, and Medicare Part B provides coverage for the program. However, participation in cardiac rehabilitation programs remains low among people covered by Medicare," said lead study author Matthew D. Ritchey, P.T, D.P.T., O.C.S., M.P.H., a researcher at the Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention. "The low participation and completion rates observed translate to upwards of 7 million missed opportunities in this study to potentially improve health outcomes if 70% of them covered by Medicare who had a heart attack or acute heart event or surgery participated in cardiac rehabilitation and completed 36 sessions."

Additional study findings included:Researchers noted that patients face systematic, logistical and cultural barriers to attending and completing an outpatient cardiac rehabilitation program. At the system level, there are no universally accepted, automated, electronic referral processes for cardiac rehabilitation services. On a personal level, patients may not complete rehabilitation due to the costs and/or the time needed to participate in the program versus returning to work and other personal commitments.

"Improving awareness of the value of cardiac rehabilitation, increasing referral of eligible patients and reducing system and patient barriers to participation are all critical steps in improving the referral, enrollment and participation rates, which, in turn, can improve patient outcomes," said Ritchey. "For example, the Agency for Healthcare Research and Quality, recently launched the TAKEheart initiative to implement automatic referral processes with care coordination to increase cardiac rehabilitation referrals, enrollment and retention across hundreds of hospitals. Each of these programs are important building blocks for continued improvement for patients."

This study had the following limitations:"It is also important to improve the capacity within existing cardiac rehabilitation programs and to address shortages in available programs, especially in rural areas. One strategy for addressing these shortages could be to increase the use of home-based or tele-cardiac rehabilitation, which have been shown to achieve similar health outcomes as compared to center-based rehabilitation care," said Ritchey.

In 2019, the American Heart Association issued a new Scientific Statement, a collaboration with the American Association for Cardiovascular and Pulmonary Rehabilitation and the American College of Cardiology, detailing the need for and benefits of home-based cardiac rehabilitation programs to improve patient access and health outcomes. The American Heart Association also supports the Increasing Access to Cardiac Rehabilitation Care Act of 2019 (H.R. 3911), introduced in the U.S. House of Representatives in July 2019. The 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation, published in April 2018, provide a comprehensive report on the performance and quality measures that can assess and improve the quality of care for patients eligible for cardiac rehabilitation.

"This study's findings confirm the urgent need to increase participation in and access to cardiac rehabilitation programs - especially since they are covered by Medicare and many insurance companies," said Randal J. Thomas, M.D., M.S., chair of the ACC/AHA Writing Committee for the joint Scientific Statement and Performance Measures Report, and medical director of the Cardiac Rehabilitation Program and Professor of Medicine at the Mayo Clinic in Rochester, Minnesota. "Cardiac rehabilitation provides essential supports, services and health care guidance that are proven to be critical to the optimal recovery of patients after a major cardiovascular event and reducing the incidence of secondary events and long-term disability. We must find ways to improve patient access to cardiac rehabilitation."
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Co-authors are Sha Maresh, Dr.P.H.; Jessica McNeely, Ph.D.; Thomas Shaffer, M.H.S.; Sandra L. Jackson, Ph.D., M.P.H.; Steven J. Keteyian, Ph.D.; Clinton A. Brawner, Ph.D.; Mary Whooley, M.D.; Tiffany Chang, M.P.H.; Haley Stolp, M.P.H.; Linda Schieb, M.P.H.; and Janet Wright, M.D.

Author disclosures are in the manuscript. There was no public or private funding for this study. The study was conducted voluntarily by a group of clinicians and researchers committed to the Million Hearts Cardiac Rehabilitation Collaborative, which is a national initiative of more than 100 organizations and agencies focused on increasing participation in cardiac rehabilitation programs from 20% to ?70% by 2022.

Additional Resources:

After January 14, view the manuscript online.
What is Cardiac Rehabilitation?
Am I Eligible for Cardiac Rehabilitation?
Cardiac Rehabilitation Tools and Resources
Cardiac Rehabilitation: Frequently Asked Questions
Home-Based Cardiac Rehabilitation Statement
2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation
Follow AHA/ASA news on Twitter @HeartNews

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

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