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. 2021 Jul;9(7):471-481.
doi: 10.1016/j.jchf.2021.02.006. Epub 2021 May 12.

Temporal Trends and Factors Associated With Cardiac Rehabilitation Participation Among Medicare Beneficiaries With Heart Failure

Ambarish Pandey  1 , Neil Keshvani  1 , Lin Zhong  1 , Robert J Mentz  2 , Ileana L Piña  3 , Adam D DeVore  2 , Clyde Yancy  4 , Dalane W Kitzman  5 , Gregg C Fonarow  6
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Free article

Temporal Trends and Factors Associated With Cardiac Rehabilitation Participation Among Medicare Beneficiaries With Heart Failure

Ambarish Pandey et al. JACC Heart Fail. 2021 Jul.
Free article

Abstract

Objectives: The purpose of this study was to assess temporal trends and factors associated with cardiac rehabilitation (CR) enrollment and participation among Medicare beneficiaries after the 2014 Medicare coverage expansion.

Background: CR improves exercise capacity, quality of life, and clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). In 2014, Medicare coverage for CR was expanded to include chronic HFrEF.

Methods: Among Medicare beneficiaries from quarter (Q) 1 2014 to Q2 2016, 11,696 patients from 14,258 hospitalizations with primary discharge diagnosis of HF were identified. Patients with HF with preserved ejection fraction were excluded. Quarterly CR participation rates among hospitalized HF patients within 6 months of discharge were identified through outpatient administrative claims. The predictors of CR participation were assessed with the use of a multivariable logistic regression model that included patient- and hospital-level characteristics. A secondary analysis to assess participation rates of CR after outpatient encounters for HF was performed.

Results: Overall, only 611 (4.3%) and 349 (2.2%) eligible patients participated CR after primary hospitalization or outpatient visit for HF, respectively. There was a modest, statistically significant increase in CR participation after HF admissions (2.8% in Q1 2014; 5.0% in Q2 2016; p < 0.001) without significant increase after outpatient visits for HF (2.6% to 3.8%; p = 0.21). Younger age, male sex, nonblack race, previous cardiovascular procedures, and hospitalization at hospitals with available CR facilities were all independently associated with CR participation.

Conclusions: CR participation among eligible Medicare beneficiaries with HFrEF was low with minimal increase since 2014 Medicare coverage decision. Sex, race, and institution-dependent variables were independent predictors of CR participation.

Keywords: Medicare; cardiac rehabilitation; exercise training; health care utilization; heart failure; predictors.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Pandey has received research funding from the Texas Health Resources Clinical Scholarship, Gilead Sciences Research Scholar Program, Applied Therapeutics (investigator-initiated grant), and National Institute of Aging (GEMSSTAR grant 1R03AG067960-01); and serves on the advisory board of Roche Diagnostics. Dr. Mentz has received research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Medtronic, Merck, Novartis, Relypsa, Respicardia, Roche, Sanofi, Vifor, and Windtree Therapeutics. Dr. DeVore has received research funding through his institution from the American Heart Association, Amgen, AstraZeneca, Bayer, Intra-Cellular Therapies, American Regent, the National Heart, Lung, and Blood Institute, Novartis, and the Patient-Centered Outcomes Research Institute; consults for Amgen, AstraZeneca, Bayer, CareDx, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals, Story Health, and Zoll; and has received nonfinancial support from Abbott for educational activities. Dr. Kitzman has consulted for Bayer, Corvia Medical, Boehringer-Ingelheim, AstraZeneca, NovoNordisk, the Duke Clinical Research Institute, and Novartis; has received grant funding from Novartis, Bayer, and Astra Zeneca; and has stock ownership in Gilead Sciences. Dr. Fonarow has received consulting with Abbott, Amgen, AstraZeneca, Bayer, Edwards, Janssen, Merck, Medtronic, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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