Related Experiment Video
Updated: Jun 30, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
The relationship between discharge location and cardiac rehabilitation use after cardiac surgery
Tyler M Bauer1, Maximilian Fliegner2, Hechaun Hou1
1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
Insights
Cardiac rehabilitation (CR) use is lower for patients discharged to extended care facilities (ECFs), despite CR improving survival more in this group. Interventions are needed to boost CR enrollment for ECF patients.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiac rehabilitation (CR) is recommended for cardiac surgery patients to reduce risks and improve outcomes.
- Despite proven benefits, CR attendance rates remain suboptimal.
- The impact of discharge location on CR utilization is not well understood.
Purpose of the Study:
- To investigate the association between patient discharge location and CR attendance after cardiac surgery.
- To examine the relationship between CR use, discharge location, and 1-year mortality.
Main Methods:
- Nationwide retrospective cohort analysis of Medicare fee-for-service claims.
- Included patients undergoing coronary artery bypass grafting and/or surgical aortic valve repair (July 2016 - Dec 2018).
- Compared CR attendance and 1-year mortality between home discharge and extended care facility (ECF) discharge groups using multivariable logistic regression.
Main Results:
- 34.1% of 167,966 eligible patients were discharged to an ECF; overall CR use was 53.9%.
- Patients discharged to ECFs had significantly lower CR use (42.1%) compared to home discharges (60.0%).
- CR attendance was linked to a greater mortality reduction in ECF patients (9.7%) versus home discharges (4.3%).
Conclusions:
- Discharge to an ECF is associated with reduced CR utilization among cardiac surgery patients.
- ECF discharge status, particularly long-term acute care, is linked to lower CR enrollment.
- Targeted interventions to increase CR enrollment at ECFs could enhance CR use and improve surgical patient outcomes.
Background:
Cardiac rehabilitation (CR) is a guideline-recommended risk-reduction program offered to cardiac surgical patients. Despite CR's association with better outcomes, attendance remains poor. The relationship between discharge location and CR use is poorly understood.
Methods:
This study was a nationwide, retrospective cohort analysis of Medicare fee-for-service claims for beneficiaries undergoing coronary artery bypass grafting and/or surgical aortic valve repair between July 1, 2016, and December 31, 2018. The primary outcome was attendance of any CR session. Discharge location was categorized as home discharge or discharge to extended care facility (ECF) (including skilled nursing facility, inpatient rehabilitation, and long-term acute care). Multivariable logistic regression models evaluated the association between discharge location, CR attendance, and 1-year mortality.
Results:
Of the 167,966 patients who met inclusion criteria, 34.1% discharged to an ECF. Overall CR usage rate was 53.9%. Unadjusted and adjusted CR use was lower among patients discharged ECFs versus those discharged home (42.1% vs 60.0%; adjusted odds ratio, 0.66; P < .001). Patients discharged to long-term acute care were less likely to use CR than those discharged to skilled nursing facility or inpatient rehabilitation (reference category: home; adjusted odds ratio for long-term acute care, 0.36, adjusted odds ratio for skilled nursing facility, 0.69, and adjusted odds ratio for inpatient rehabilitation, 0.71; P < .001). CR attendance was associated with a greater reduction in adjusted 1-year mortality in patients discharged to ECFs (9.7% reduction) versus those discharged home (4.3% reduction).
Conclusions:
In this national analysis of Medicare beneficiaries, discharge to ECF was associated with lower CR use, despite a greater association with improved 1-year mortality. Interventions aimed at increasing CR enrollment at ECFs may improve CR use and advance surgical quality.
More Related Videos
Related Concept Videos
01:31Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
01:19Restorative Care
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...