Cardiac Rehabilitation Trends Among Commercially Insured Adults in the United States, 2017-2023

Cardiac rehabilitation (CR) reduces morbidity and mortality among individuals with heart disease. Although the COVID-19 pandemic disrupted health services, its impact on CR participation remains poorly understood-especially among commercially insured populations, for whom CR utilization trends are poorly documented.

This cross-sectional time series study of enrollees aged 18 to 64 years with ≥1 CR-qualifying event (acute myocardial infarction, coronary artery bypass graft, heart valve repair/replacement, percutaneous coronary intervention, or heart/heart-lung transplant) during 2017 to 2022, with follow-up through 2023, used MarketScan commercial claims data. Adjusted analyses used Poisson log-linear models with robust standard errors to examine trends in enrollment and completion (≥36 sessions), and generalized linear models with negative binomial distribution and log-link function to examine trends in days to enrollment and number of sessions.

The sample included 143 870 unique individuals aged 18 to 64 years with a CR-qualifying event. Of the sample, the mean age was 53.9 (SD, 8.1), and 70% were men. On average, from 2017 to 2023, enrollment was 24.2%, days to enrollment were 46.3 (SD, 51.4 days), the number of sessions was 13.9 (SD, 12.8), and completion was 9.6%. Compared with year 2017, 2020 was associated with a 12% lower prevalence of enrollment (adjusted prevalence ratio, 0.88 [95% CI, 0.85-0.90]), 6-day longer time to enrollment on average (adjusted difference, 6.04 [95% CI, 4.36-7.72]), 1.2 fewer sessions on average (adjusted difference, -1.24 [95% CI, -1.72 to -0.75]), and 13% lower prevalence of completion (prevalence ratio, 0.87 [95% CI, 0.78-0.97]). All metrics rebounded to prepandemic levels, except days to enrollment (4 days longer in 2022 versus 2017; adjusted difference, 3.78 [95% CI, 2.22-5.34]).

Among commercially insured adults <65 years, only one-quarter of eligible individuals participated in CR. CR metrics worsened during the COVID-19 pandemic in 2020, but most rebounded to prepandemic levels. These findings highlight an opportunity for health systems and public health initiatives to support broader CR uptake.