Abstract 12759: Utilization of Cardiac Rehabilitation Among Patients With Heart Failure

Abstract

Introduction: Cardiac rehabilitation (CR) is linked to reduced mortality and morbidity including improvements in cardiorespiratory fitness, psychosocial state, and quality of life in patients with heart failure (HF). However, little is known about CR utilization among patients with HF. We sought to determine: a) the proportion of patients with HF who participated in CR during a 5-year period; and b) patient characteristics associated with participation. Methods: A retrospective study was conducted using national data from the Centers for Medicare & Medicaid Services (CMS 5% random sample) and the Veterans Health Administration (VA) Healthcare System. We used primary discharge ICD-9 codes to identify all patients hospitalized for HF between 1/2007 and 12/2011. After excluding patients who died within 30 days of hospitalization, we identified participation in CR programs using CPT codes from Medicare and VA claims data. Multivariate logistic regression was used to identify patient characteristics independently associated with CR participation. Results: During the five-year study period, 66,710 Veteran patients and 243,208 of the 5% Medicare sample were hospitalized for HF. Of these, 1,554 Veterans (2.3%) and 6,280 Medicare beneficiaries (2.6%) attended one or more sessions of outpatient CR. Among Medicare beneficiaries, men were more likely than women to participate in CR (3.7% vs. 1.8%; p<0.001), but there was no gender difference in Veterans (2.3% vs. 2.8%; p=0.40). Characteristics associated with participation in CR among both VA and CMS patients included younger age, white race, and history of ischemic heart disease. Chronic conditions such as diabetes, chronic obstructive pulmonary disease, chronic kidney disease, and depression were associated with lower participation in CR. Conclusions: Very few HF patients participated in CR between 2007 and 2011, but participation was especially low among older, non-white women with a history of depression or other chronic medical conditions. Since Medicare has recently introduced coverage for CR in patients with systolic HF, we must increase efforts to improve CR participation, especially among these vulnerable groups.