Cardiac Rehabilitation Attendance Low Among Medicare Beneficiaries
JANUARY 14, 2020
Patrick Campbell
Matthew Ritchey, DPT, MAn analysis of Medicare data has uncovered a startling trend regarding rehabilitation for patients who suffered a cardiovascular event or surgery.Results of the analysis, which was led by Matthew Ritchey, DPT, MPH, of the Centers for Disease Control Prevention (CDC), indicated less than 1 in 4 eligible patients participated in a cardiac rehabilitation program and just 24% of those who did participate started the program within 21 days of the event or surgery"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,” said Ritchey, a researcher at the CDC’s Division for Heart Disease and Stroke Prevention, in a press release.
The shocking news is that this is a fully covered Medicare Benefit.
Inclusion criteria included experiencing 1 or more AMI hospitalization, CABG, heart valve repair or replacement, percutaneous coronary intervention, or heart or lung transplant. Patients also needed to be alive for more than 21 days following their qualifying event, have continuous Medicare Part A and Part B enrollment for 12 or more months following the event if they survived to that point, and not be entitled to Medicare benefits due to having an end-stage renal disease.
Using these criteria, investigators identified a cohort of 366,103 patients who were eligible for cardiac rehabilitation, of which 89,327 (24.4%) participated in such a program. Further analysis revealed only 24.3% of those who participated began within 21 days of the event or procedure and just 26.9% of participants completed cardiac rehabilitation.
Results also indicated participation varied based on the ethnicity of the beneficiary. Participation rates were highest among Non-Hispanic whites, with non-Hispanic blacks being 0.7 times (adjusted prevalence rate [aPR] 0.70; 95% CI, 0.67–0.72) as likely and Hispanics 0.63 times (aPR 0.63; 95% CI, 0.61–0.66) as likely to participate than their white counterparts.
Using these criteria, investigators identified a cohort of 366,103 patients who were eligible for cardiac rehabilitation, of which 89,327 (24.4%) participated in such a program. Further analysis revealed only 24.3% of those who participated began within 21 days of the event or procedure and just 26.9% of participants completed cardiac rehabilitation.
Results also indicated participation varied based on the ethnicity of the beneficiary. Participation rates were highest among Non-Hispanic whites, with non-Hispanic blacks being 0.7 times (adjusted prevalence rate [aPR] 0.70; 95% CI, 0.67–0.72) as likely and Hispanics 0.63 times (aPR 0.63; 95% CI, 0.61–0.66) as likely to participate than their white counterparts.
Age also appeared to impact participation rates among beneficiaries. Among those 85 years and older, only 9.8% (aPR 0.57; 95% CI, 0.56–0.59) of eligible beneficiaries participated in a rehab program—compared to 24.8% (aPR 0.93; 95% CI, 0.92–0.95) among those 75 to 84, and 31.7% among those 65 to 74 years old.
Ritchey and colleagues noted multiple limitations to consider when interpreting the results of their analysis. Limitations included being unable to assess referral rates with the use of billing data, clinical information was not available for all patients, investigators were unable to control for factors such as availability of programs, and because only cardiac rehabilitation was assessed results may not be generalizable to Medicare Advantage members or younger patients.
Based on the results of their analyses, Ritchey suggests more work is needed to promote and encourage participation in cardiac rehabilitation programs if clinicians seek to maintain the improvements in cardiovascular outcomes seen in recent years.
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.
Despite the importance of CR use to improve health outcomes after a qualifying cardiac event, participation and completion remain low among eligible Medicare FFS beneficiaries. Furthermore, disparities and considerable geographic variability persist. A wealth of guidance exists that identifies the evidence-based strategies that can be used to increase CR use. Hospitals, CR programs, and other stakeholders can consider systematically integrating these strategies into their processes and tracking the effects of their implementation using established quality and performance measures. Continued innovation in the delivery of services may help meet the needs of the groups most underserved, as well as to increase the capacity to provide care for all those who qualify. The findings in this article and future analyses can be used to assess the impact these collective efforts have on achieving national CR utilization goals.
There is a serious disconnect between cardiologists, cardiothoracic surgeons, and their patients. Preoperative counseling should include the necessity of post-operative rehabilitation In the cases of open heart surgery chest wall physiology is radically altered due to the opening of the thoracic cavity. For patients in heart failure prior to diagnosis and treatment, it is likely that patients have become de-conditioned due to dyspnea and fatigue. Once treated their body literally has to catch up with a healthier heart/
There is a serious disconnect between cardiologists, cardiothoracic surgeons, and their patients. Preoperative counseling should include the necessity of post-operative rehabilitation In the cases of open heart surgery chest wall physiology is radically altered due to the opening of the thoracic cavity. For patients in heart failure prior to diagnosis and treatment, it is likely that patients have become de-conditioned due to dyspnea and fatigue. Once treated their body literally has to catch up with a healthier heart/
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