Abstract 13171: Cardiac Rehabilitation and COVID-19: Nationwide Declines in Access and Participation Among Medicare Beneficiaries

Abstract

Introduction: The effect of the COVID-19 pandemic on availability of and participation in cardiac rehabilitation (CR) participation is unknown. Methods: We used Medicare Fee-for-Service claims, American Hospital Association surveys, and Rural Urban Commuting Area codes to evaluate CR center availability and CR participation (01/2019-12/21). Results: Medicare beneficiaries participated in a mean ± SD of 56,898 ± 2,046 CR sessions per month from 01/2019 - 02/2020. Immediately after the announcement of the public health emergency in 03/2020, CR sessions declined by 93% (to 3,989 sessions in 04/2020) (Figure). The monthly CR sessions recovered gradually through 12/21, but CR participation remained 17% lower than pre-pandemic levels (54,730 ± 2,340 sessions/month in Q1 2019 vs. 45,209 ± 326 sessions/month in Q4 2021, p<0.01). Prior to the pandemic, Medicare beneficiaries received CR at 2,631 ± 8 CR centers. Only 688 centers were in operation in 04/2020 (a 74% decline from pre-pandemic levels), with slow and incomplete recovery in the following months. The number of CR centers in 12/2021 was 5% lower than pre-pandemic levels (2,620 ± 6 centers available in Q1 2019 vs. 2,485 ± 8 centers available in Q4 2021, p <0.01). Ownership status (private/not for profit, private/for profit and public/municipal), teaching status affiliation (major, minor and none), and location (metro, micro and rural) were not associated with post-pandemic CR center availability. Conclusions: The COVID-19 pandemic has been associated with persistent declines in the availability of CR centers and participation in CR sessions among Medicare beneficiaries. Future studies should examine the impact of these closures on health outcomes and equity. Meeting the Million Hearts Initiative’s goal of equitably increasing CR participation will require scalable innovation in CR financing and delivery.