Abstract 173: Regional Variation in Cardiac Rehabilitation Participation within the Medicare and Veterans Health Administration Populations

Abstract

Introduction: Cardiac rehabilitation is a guideline-recommended therapy for patients after acute myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass surgery (CABG). However, participation in cardiac rehabilitation is notoriously poor. Evaluating variation in health care delivery can help to identify best practices that improve quality of care more broadly. Therefore, we sought to examine regional variation in the percent of patients who participate in cardiac rehabilitation across the United States. Methods: We used ICD-9 codes from Medicare and Veterans Health Administration (VHA) data to identify patients hospitalized for MI, PCI, or CABG between 1/1/2007 and 12/31/2009 (in a 5% Medicare sample) or 10/1/2006 and 9/30/2011 (in VHA). After excluding patients who died within 30 days of hospitalization, we calculated the percent of patients who participated in one or more outpatient visits for cardiac rehabilitation (CPT code 93797 or 93798) during the 12 months after hospitalization. We then compared the percent of patients who participated in cardiac rehabilitation by state. Hawaii and Alaska were excluded from the analysis because they do not have VHA inpatient facilities. Results: Overall participation in cardiac rehabilitation was 20% (13,435/67,115) in Medicare and 8% (3,955/47,051) in VHA. Similar regional variation was observed, with the North-Central United States having the highest participation in both health care systems (Figure). Within Medicare, participation in cardiac rehabilitation ranged from 10% (Nevada) to 52% (Nebraska). Within VHA, participation ranged from 0 (Delaware, New Jersey) to 30% (Nebraska). Conclusion: Similar regional variation in participation in cardiac rehabilitation was observed in two separate health care systems. Nebraska had the highest rate of participation in both Medicare and VHA populations. Further study of reasons for regional variation and differences in regional variation in these populations may reveal opportunities for improving delivery of cardiac rehabilitation.