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 findings 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 -- a number that doesn't include those with qualifying heart failure.
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.
WHAT'S THE IMPACT
In the review of more than 366,000 patients covered by Medicare who were eligible for outpatient cardiac rehabilitation in 2016, it was found that only about 25% participated in a cardiac rehabilitation program, totaling about 90,000 people.
Among those who participated in cardiac rehabilitation, only 24% began the program within 21 days of the acute cardiac event or surgery; and only about 27% completed the full course of the recommended 36 or more cardiac rehabilitation sessions, which have been shown to improve health outcomes.
Medicare Part D provides coverage for the program, but the low participation and completion rates correlate to about 7 million missed opportunities to improve health outcomes, assuming 70% of those covered completed 36 sessions of cardiac rehabilitation.
Among the other findings was that participation in outpatient cardiac rehabilitation decreased with increasing age, with only about 10% of patients age 85 and older participating, as compared to about 32% of those age 65 to 74.
Participation was lower among women than men, about 19% versus about 29%, respectively. 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.
THE LARGER TREND
In 2019, the American Heart Association issued what it called a 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, 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.