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Cardiac rehabilitation enrollment after surgery low despite benefits
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Cardiac rehabilitation is linked to a decreased risk for 1-year cumulative hospitalization and mortality risk in Medicare beneficiaries after cardiac valve surgery, but fewer than half of these patients were enrolled in a program, according to a study published in JAMA Cardiology.
“This work is relevant to value-based health care delivery models,” Devin K. Patel, MD, clinical fellow in the division of cardiovascular medicine at Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues wrote. “Cardiac rehabilitation will likely play an integral role in bundled services including those associated with cardiac valve surgery.”
Medicare beneficiaries
Researchers analyzed data from 41,369 Medicare beneficiaries (median age, 73 years; 41% women) who underwent cardiac valve surgery in 2014, which included open replacement, valvuloplasty or repair of the mitral, aortic, pulmonary or tricuspid valves.
The primary exposure was enrollment in cardiac rehabilitation programs, and the secondary exposure was the number of sessions attended for cardiac rehabilitation. Secondary outcomes were defined as all-cause mortality and hospitalizations within 1 year of discharge.
Of the patients in the study, 43.2% were enrolled in cardiac rehabilitation programs. Compared with white patients, lowers odds of cardiac rehabilitation enrollments were seen in black patients (OR = 0.6; 95% CI, 0.54-0.67), Asian patients (OR = 0.36; 95% CI, 0.28-0.47) and Hispanic patients (OR = 0.36; 95% CI, 0.28-0.46).
Higher odds of cardiac rehabilitation enrollment were seen in patients who underwent concomitant CABG compared with those who did not (OR = 1.26; 95% CI, 1.2-1.31). Increased enrollment was also seen in patients from the Midwest census region vs. the South (OR = 2.4; 95% CI, 2.28-2.54).
Patients who were enrolled in cardiac rehabilitation had fewer hospitalizations (HR = 0.66; 95% CI, 0.63-0.69) and a 4.2% absolute decrease in mortality risk at 1 year (HR = 0.39; 95% CI, 0.35-0.44).
“These results invite further study on barriers to cardiac rehabilitation enrollment in patients who have had cardiac valve surgery, as well as efforts to expand cardiac rehabilitation access to groups of patients who have had cardiac valve surgery and have particularly low enrollment rates,” Patel and colleagues wrote.
Potential for updated coverage policies
Randal J. Thomas, MD, MS, medical director of the Mayo Clinic Cardiac Rehabilitation Program, and LaPrincess C. Brewer, MD, MPH, cardiologist and assistant professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, wrote in a related editorial: “As cardiac rehabilitation delivery methods, quality improvement practices and coverage policies continue to evolve, health care practitioners and policymakers must implement more effective and innovative strategies to improve delivery of cardiac rehabilitation services to all eligible patients including those patients undergoing heart valve surgery. Little by little, as additional scientific evidence and innovative delivery strategies continue to expand, such efforts will help patients travel far on the road to optimal rehabilitation and secondary prevention outcomes.” – by Darlene Dobkowski
Disclosures: Patel, Thomas and Brewer report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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