Cardiac rehabilitation use varies by region, urbanization
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Use of cardiac rehabilitation varied based on U.S. region and on urbanization status, researchers reported in JAMA Cardiology.
Cardiac rehabilitation eligibility, participation and completion rates for residents of large urban areas were lower than the highest levels among noncore rural area residents despite the former having greater numbers of cardiac rehabilitation centers per county, the researchers wrote.
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“Data reported in U.S. studies are decades old, and cardiac rehabilitation has yet to be described nationally across modern urbanization classifications. Characterizations of urban vs. rural areas and cardiac rehabilitation use in non-U.S. countries are also not generalizable to the U.S. Clarifying modern urban-rural disparities in center-based cardiac rehabilitation use throughout the U.S. may generate the information needed to develop solutions for increasing cardiac rehabilitation use,” Erik H. , PhD, director of cardiac rehabilitation and quality director of metabolic exercise stress testing in the Heart, Vascular and Thoracic Institute at Cleveland Clinic, and colleagues wrote. “We aimed to characterize geographical and urban-rural patterns in cardiac rehabilitation eligibility and center-based cardiac rehabilitation use throughout the U.S.”
The researchers conducted a cross-sectional study collecting county-level cardiac rehabilitation eligibility rates, participation rates, adherence rates and completion rates from 2017 to 2018 for Medicare fee-for-service beneficiaries aged 65 years or older.
Van Iterson and colleagues found that participation and completion rates varied by region and urbanization classification, and in many cases, rates in large central metro areas, which had the highest proportion of cardiac rehabilitation centers, were lower than that in other areas.
Participation varied greatly nationwide (X² = 162.44; P < .001), and there were significant interactions between geographical region and urbanization classification that suggested urban-rural associations with cardiac rehabilitation eligibility (X² = 39.48; P < .001), the researchers wrote.
Southern rural area residents had high cardiac rehabilitation eligibility rates but low participation rates, which differed from rural patterns in Midwestern, Northeastern and Western regions, the researchers wrote.
“Although no causal associations can be established from the findings, this study presented contemporary observations that may help shape future discussions on urban-rural health policies and practice-level interventions to increase cardiac rehabilitation use throughout the U.S.,” Van Iterson and colleagues wrote.
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