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Cardiac Rehabilitation Among Veterans: A Narrative Review
Merilyn S Varghese1, Wen-Chih Wu, Kariann R Drwal
1Author Affiliations: VA Connecticut Healthcare System, West Haven, Connecticut (Drs Varghese, Burg, Gaffey, Brandt, Bastian, and Gandhi); Yale School of Medicine, New Haven, Connecticut (Drs Varghese, Burg, Gaffey, Brandt, Bastian, Gandhi); Providence VA Medical Center and the Miriam Hospital Cardiovascular Rehabilitation Center, Providence, Rhode Island (Dr Wu); Departments of Medicine, Epidemiology and Center for Global Cardiometabolic Health, Brown University, Providence, Rhode Island (Dr Wu); VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa (Dr Drwal); The Center for Access and Delivery Research and Evaluation (CADRE) Iowa City VA Healthcare System, Iowa City, Iowa (Dr Drwal); Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Kazi); Harvard Medical School, Boston, Massachusetts (Dr Kazi); VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts (Dr Mattocks); and University of Massachusetts Medical School, Worcester, Massachusetts (Dr Mattocks).
Purpose:
Cardiac rehabilitation (CR) is a valuable secondary preventive intervention for Veterans given their increased risk of cardiovascular disease. Adults cared for in the Veterans Affairs (VA) healthcare system are a unique population that receives healthcare from the largest integrated care network in the United States. Yet, this group faces distinct challenges in utilizing CR. In this review, we evaluated the existing data regarding CR utilization and outcomes among U.S. Veterans.
Review Methods:
A literature search was conducted using PubMed and Scopus for cardiac rehabilitation and U.S. Veterans.
Summary:
Veterans have 3 potential options for attending CR: in-person at their local VA medical centers, home-based CR through their local VA medical centers, and in-person at community CR centers. However, participation remains low. A significant barrier to participation is transportation to in-person CR. Home-based CR shows promise in addressing this barrier and has demonstrated resilience in the face of pandemic restrictions. Cardiac rehabilitation outcomes among Veterans who participate include improved exercise capacity, fewer depressive symptoms, and decreased mortality. Despite its benefits for secondary prevention among Veterans, there remains a paucity of data about the current uptake of CR, the impact of mental health on uptake, possible sex-based or racial disparities, and long-term outcomes.
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