Abstract 16497: Intensive Cardiac Rehabilitation and Traditional Cardiac Rehabilitation are Markedly Underutilized: Results From a Medicare Sample Analysis

Abstract

Introduction: Cardiac rehabilitation (CR) is proven to improve cardiovascular outcomes in patients with heart disease. Intensive cardiac rehabilitation (ICR) was developed to enhance CR by adding sessions focused on nutrition, education, and stress management. ICR improves adiposity, lipid profiles, and exercise capacity vs. CR and has been Medicare-approved since 2010. Little is known about national utilization rates of ICR in the Medicare population or baseline characteristics associated with its use. Methods: A 5% sample of Medicare claims data from 2012 to 2015 was used to identify beneficiaries with a qualifying indication for CR/ICR (MI, CABG, valve surgery, PCI, heart transplant, heart failure, stable angina) and to quantify utilization of CR or ICR within 1 year of the index qualifying diagnosis. Results: From 2012-2015, there were 111,432 qualifying events in 107,261 Medicare beneficiaries. On average in this 5% sample, 15.6% of eligible beneficiaries (n = 17,422) completed at least 1 session of CR and only 0.1% (n = 108) completed at least 1 session of ICR. Rates of CR and ICR use (combined) increased by 2.95% to only 17.55% (Figure). The number of ICR centers (14 to 29 centers) increased over these 3 years. Those who attended CR or ICR were younger, more likely to be male and white, and have higher median income compared with eligible beneficiaries who did not attend. While participants that attended CR lived closer to the center (CR 5.5 miles; ICR 7.2 miles; p=0.01), there were no differences between CR and ICR enrollees with respect to age, sex, race, discharge location, median income, dual enrollment (Medicare + Medicaid), or number of comorbidities. Conclusions: Although the number of ICR centers has increased, CR and ICR remain markedly underutilized and ICR is not yet widely available. Continued research is needed to understand the barriers to program development, patient participation.