Cardiac rehab access, participation yet to return to pre-pandemic levels
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CHICAGO — The number of Medicare beneficiaries participating in cardiac rehabilitation dropped significantly at the onset of the pandemic and had yet to return to pre-pandemic levels as of December 2021, a speaker reported.
In addition, 8% of centers failed to reopen as of December 2021, of which many provided care socially vulnerable communities, according to data presented at the American Heart Association Scientific Sessions.
“Our findings suggest that cardiac rehabilitation use declined precipitously during the early part of the pandemic and has recovered slowly yet incompletely. This decline is not explained by a reduction in the number of eligible patients. Instead, it is due to fewer eligible patients starting cardiac rehabilitation,” Dhruv S. Kazi, MD, MSc, MS, associate director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, director of the cardiac critical care unit at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School, told Healio. “At a time when the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services are making a concerted effort to increase cardiac rehabilitation use threefold, 220 cardiac rehabilitation centers closed down, further exacerbating access disparities. And while the policy change to cover virtual cardiac rehabilitation has helped spur uptake, the growth in virtual cardiac rehabilitation is completely overshadowed by the decline in in-person cardiac rehabilitation (hence the net decline in cardiac rehabilitation participation). Strategies to equitably increase access to cardiac rehabilitation are urgently needed to ensure that the benefit of this potentially lifesaving therapy reaches patients most likely to benefit from it.”
Varghese and colleagues utilized Medicare fee-for-service claims, American Hospital Association surveys and Rural Urban Commuting Area codes to assess cardiac rehabilitation center availability and participation from January 2019 through December 2021.
The analysis was simultaneously published in Circulation: Cardiovascular Quality and Outcomes.
The researchers compared the number of cardiac rehab sessions per 100,000 Medicare beneficiaries, patients eligible to initiate cardiac rehab and centers offering cardiac rehab from December 2019 to February 2020, before the pandemic, and from October 2021 to December 2021, the most recent period for which data were available when the analysis was undertaken.
During the pre-pandemic period, the rate of cardiac rehab participation was 895 sessions per 100,000 beneficiaries per month, which dropped to 56 per 100,000 beneficiaries in April 2020. By October to December 2021, the rate rose to 698 sessions per 100,000 beneficiaries per month, which remained lower than the pre-pandemic period (P = .02), according to the researchers.
The declines in enrollment were most prominent in patients with dual Medicare and Medicaid eligibility and in patients living in rural areas or socially vulnerable communities, Kazi and colleagues found.
There were no differences between the periods in patients eligible to initiate cardiac rehab.
The number of centers offering cardiac rehab dropped from 2,618 in the pre-pandemic period to 2,464 in October to December 2021 (P < .01), according to the researchers.
The centers that remained closed were more likely affiliated with public hospitals; located in rural areas; and provided care in socially vulnerable communities, according to the study.
“Significant innovation to facilitate cardiac rehabilitation delivery is essential, particularly for patients with access disparities,” Merilyn S. Varghese, MD, research fellow at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and clinical cardiology fellow at Beth Israel Deaconess Medical Center and Harvard Medical School, told Healio. “For patients living in cardiac rehabilitation deserts (areas without cardiac rehabilitation available), novel care models, including virtual cardiac rehabilitation, can help improve access. Overall, multifaceted solutions are needed to address the declines both in patients participating in cardiac rehabilitation and in cardiac rehabilitation center availability.”
Reference:
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Varghese MS, et al. Abstract 289. Presented at: American Heart Association Scientific Sessions; Nov. 5-7, 2022; Chicago (hybrid meeting).
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