Abstract 14253: Distance to Cardiac Rehabilitation is Associated With Participation and Completion

Abstract

Background: Despite the known benefits for patients undergoing coronary revascularization, cardiac rehabilitation (CR) use remains low, with few studies evaluating geographic barriers to care. In this analysis, we examined geographic access (i.e. distance) to a CR facility and its relationship to CR participation and completion. Methods: A cohort of 414,730 Medicare beneficiaries with coronary revascularization were identified from 2016-2018. Geographic access was defined as the presence of a CR facility within the beneficiary’s home zip code (yes vs. no) and the distance to the nearest CR facility: within the same zip code (0 miles), 0-10 miles, 10-20 miles, 20+ miles. We then used claims data to determine any CR participation within one year of discharge and completion of the full CR program (36 sessions). Multivariable logistic regression was used to identify the relationships, adjusting for patient factors. Results: A total of 155,872 (37.6%) beneficiaries participated in CR during the study period, with 45,591 (29.3%) completing 36 sessions. Nearly a quarter of beneficiaries had a CR facility located within their residential zip code (23.7%), with the majority of beneficiaries having a CR facility within 10 miles of the center of their home zip code ( Table 1). Beneficiaries without a CR facility in their zip code were more likely to be younger in age, men, non-white race categories, dual eligible for Medicare/Medicaid, and increasingly comorbid. Adjusting for patient factors, increasing distance category was associated with an absolute reduction in CR participation and completion (Table 1) . Conclusions: Distance to the nearest CR facility is an important predictor of CR participation and completion, with overall use declining as distance increased. Interventions to address geographic barriers, such as transportation programs or virtual/hybrid CR, may be necessary to improve CR participation in areas with limited facility access.