Nav: Home

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:
  • only about 25% (approximately 90,000) participated in a cardiac rehabilitation program;
  • among those who participated in cardiac rehabilitation, only 24% began the program within 21 days of the acute cardiac event or surgery; and
  • among those who participated in cardiac rehabilitation, only about 27% completed the full course of the recommended 36 or more cardiac rehabilitation sessions, which have been shown to improve health outcomes.
"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:
  • Participation in outpatient cardiac rehabilitation decreased with increasing age, with only about 10% of patients age 85 and older participating, versus about 32% of those age 65 to 74.
  • Participation was lower among women than men, about 19% versus about 29%, respectively.
  • Over half of the cardiac rehab eligible patients had less than 5 comorbid conditions.
  • Non-Hispanic whites had the highest participation rate at about 26%, versus 16% for Asians, 14% for non-Hispanic blacks and 13% for Hispanics.
  • Participation also varied by region, with cardiac rehabilitation being lowest in the Southeastern United States and the Appalachian region.
  • Patients who had a procedure such as coronary bypass surgery were more likely to participate in cardiac rehabilitation than those who had a heart attack with no procedure performed.
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:
  • Billing codes were used to identify patients eligible for cardiac rehabilitation, however, referral rates cannot be assessed with use of billing data.
  • Clinical information was not available for patients; therefore, the authors were unable to validate the billing codes used or to exclude patients who may not have been appropriate for cardiac rehabilitation.
  • This study was restricted to assessing cardiac rehabilitation use among older patients with Original Medicare coverage, therefore, the findings may not be generalizable to Medicare Advantage members or to younger patients.
  • The authors were unable to control for factors that may have affected their findings such as the availability of cardiac rehabilitation programs in certain communities.
"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."
-end-
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

Related Heart Disease Articles:

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.
With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.
Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.
Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.
Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.
New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.
Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.
Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.
Women once considered low risk for heart disease show evidence of previous heart attack scars
Women who complain about chest pain often are reassured by their doctors that there is no reason to worry because their angiograms show that the women don't have blockages in the major heart arteries, a primary cause of heart attacks in men.
Where you live could determine risk of heart attack, stroke or dying of heart disease
People living in parts of Ontario with better access to preventive health care had lower rates of cardiac events compared to residents of regions with less access, found a new study published in CMAJ (Canadian Medical Association Journal).
More Heart Disease News and Heart Disease Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Sound And Silence
Sound surrounds us, from cacophony even to silence. But depending on how we hear, the world can be a different auditory experience for each of us. This hour, TED speakers explore the science of sound. Guests on the show include NPR All Things Considered host Mary Louise Kelly, neuroscientist Jim Hudspeth, writer Rebecca Knill, and sound designer Dallas Taylor.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

Kittens Kick The Giggly Blue Robot All Summer
With the recent passing of Ruth Bader Ginsburg, there's been a lot of debate about how much power the Supreme Court should really have. We think of the Supreme Court justices as all-powerful beings, issuing momentous rulings from on high. But they haven't always been so, you know, supreme. On this episode, we go all the way back to the case that, in a lot of ways, started it all.  Support Radiolab by becoming a member today at Radiolab.org/donate.