Interhospital variability in cardiac rehabilitation use after cardiac surgery among Medicare beneficiaries

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• Cardiac rehabilitation (CR) is recommended after cardiac surgery but remains underutilized.
• Significant interhospital variability exists in CR participation rates, with unclear contributing factors.

Purpose of the Study:

• To evaluate the determinants of interhospital variability in CR use following cardiac surgery.
• To assess the association between CR use and patient outcomes (mortality, readmission).

Main Methods:

• Retrospective cohort study of 166,809 Medicare beneficiaries undergoing cardiac surgery (2016-2018).
• CR participation identified via claims data within one year of discharge.
• Multilevel models analyzed patient, organizational, and regional factors influencing CR variability; outcomes assessed by hospital CR use quartiles.

Main Results:

• Overall CR participation was 54.1%, with interhospital rates ranging from 0.0% to 96.8%.
• Hospital factors like nonteaching status and lower volume predicted lower CR use.
• Hospitals with the lowest CR use (Q1) had significantly higher adjusted 1-year mortality (6.7%) and readmission rates (37.6%) compared to the highest use quartile (Q4: 5.2% mortality, 33.9% readmission).

Conclusions:

• Interhospital variability in CR use is substantial and influenced by hospital, structural, and regional factors.
• Identifying best practices in high-use facilities and addressing access barriers in low-use facilities can improve CR uptake.
• Reducing CR use disparities is crucial for advancing national cardiac surgery recovery efforts.