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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Participation in Cardiac Rehabilitation Among Patients With Heart Failure
Linda G Park1, David W Schopfer2, Ning Zhang3
1San Francisco Veterans Affairs Medical Center, San Francisco, California; School of Nursing, Department of Community Health Systems, University of California, San Francisco, California.
Insights
Few heart failure patients utilize cardiac rehabilitation (CR). Participation is lower in older, non-white women with other health issues, highlighting a need to improve CR access for these vulnerable populations.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiac rehabilitation (CR) improves outcomes for heart failure (HF) patients, including fitness and quality of life.
- However, CR utilization rates among HF patients remain largely unknown.
- Understanding CR use is crucial for optimizing patient care.
Purpose of the Study:
- To determine the proportion of heart failure patients participating in CR.
- To identify patient characteristics associated with CR participation.
Main Methods:
- Retrospective analysis of national Medicare and Veterans Health Administration data (2007-2011).
- Identified HF hospitalizations using ICD-9 codes.
- Assessed CR participation via procedure codes in claims data.
- Used logistic regression to identify factors associated with CR use.
Main Results:
- Low CR participation rates observed: 2.3% for veterans and 2.6% for Medicare beneficiaries.
- Men were more likely to participate in CR than women among Medicare beneficiaries (3.7% vs 1.8%).
- Younger age, white race, and a history of ischemic heart disease were linked to higher CR participation in both groups.
Conclusions:
- Very few heart failure patients engage in CR, particularly older, non-white women with comorbidities.
- Increased efforts are needed to promote CR participation, especially among underrepresented and vulnerable HF patient groups.
- Recent Medicare coverage for CR in systolic HF necessitates targeted interventions to improve access and uptake.
Background:
Cardiac rehabilitation (CR) is linked to reduced mortality and morbidity, including improvements in cardiorespiratory fitness, psychosocial state, and quality of life in patients with heart failure (HF). However, little is known about CR utilization among patients with HF.
Objective:
We sought to determine (a) the proportion of patients with HF who participated in CR and (b) patient characteristics associated with participation.
Methods:
A retrospective study was conducted with the use of national data from the Centers for Medicare and Medicaid Services and the Veterans Health Administration. We used primary discharge ICD-9 codes to identify patients hospitalized for HF during 2007-2011 and identified CR participation with the use of current procedure terminology codes from claims data. Multivariate logistic regression was used to identify patient characteristics associated with CR participation.
Results:
There were 66,710 veterans and 243,208 Medicare beneficiaries hospitalized for HF and 1554 (2.3%) and 6280 (2.6%), respectively, who attended ≥1 sessions of outpatient CR. Among Medicare beneficiaries, men were more likely than women to participate in CR (3.7% vs 1.8%; P < .001), but there was no gender difference among veterans (2.3% vs 2.8%; P = .40). Characteristics associated with participation in CR in both groups included younger age, white race, and history of ischemic heart disease.
Conclusions:
Very few HF patients participated in CR, with lower rates among older non-white women with a history of depression or other chronic medical conditions. Because Medicare has recently introduced coverage for CR in patients with systolic HF, we must increase efforts to improve CR participation, especially among these vulnerable groups.
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