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Cardiac rehabilitation use among veterans low, improved with on-site programs
Veteran enrollment in outpatient cardiac rehabilitation programs was low from 2006 to 2011, but increased with the availability of on-site cardiac rehabilitation programs, according to recent study findings in JAMA Internal Medicine.
David W. Schopfer, MD, MAS, from the department of medicine at San Francisco Veterans Affairs Medical Center, and colleagues examined the inpatient files of patients discharged from 124 Veterans Health Administration facilities with a diagnosis of MI, PCI or CABG (N=47,051) from 2007 to 2011.
Of those patients, 3,955 (8.4%) participated in one or more sessions of outpatient cardiac rehabilitation during the first year after hospitalization. Participation rates increased over time, from 7.5% in 2007 to 9.4% in 2011 (P<.01).
“Referral to exercise-based cardiac rehabilitation is one of nine performance measures for secondary prevention after hospitalization for MI, PCI and/or CABG,” the researchers wrote. “Although cardiac rehabilitation programs significantly reduce morbidity and mortality in patients with ischemic heart disease, they are vastly underused among US Medicare beneficiaries.”
Analyses were stratified by the presence (n=35 VA facilities) or absence (n=89 VA facilities) of an on-site cardiac rehabilitation program. The researchers found that patients were more likely to attend cardiac rehabilitation if they had been hospitalized at a facility with an on-site program, compared with hospitalization at a facility without cardiac rehabilitation (10.9% vs 6.8%; P<.001). Patient proximity to a VA facility with on-site cardiac rehabilitation was also associated with greater participation rates (P=.02).
Additionally, the researchers examined the characteristics of participants of cardiac rehabilitation. They found no significant difference in participation by sex or race; 8.4% of men and 7.9% of women participated in cardiac rehabilitation and 8% of participants were white and 8.3% were nonwhite. However, white participants were more likely than nonwhite participants to attend non-VA cardiac rehabilitation programs (P=.001) and less likely to attend on-site VA programs (P=.02).
Other characteristics associated with greater participation in cardiac rehabilitation were younger age, marriage, higher BMI, hyperlipidemia, absence of HF, absence of chronic kidney disease and hospitalization for CABG.
“These findings suggest that new patient-centered deliver strategies must be developed to solve the seemingly intractable challenge of CR underuse,” the researchers concluded.
Disclosure: One researcher reports receiving research funding from Janssen Healthcare Innovations.