Abstract 19209: Utilization of Inpatient Cardiac Rehabilitation During a Hospitalization for a Cardiac Condition: A National Sample

Abstract

Introduction: Inpatient cardiac rehabilitation (ICR) programs provide important services to patients, including daily ambulation, risk factor education, and coordinated referral to outpatient cardiac rehabilitation. However, little is known about national current utilization or practice patterns. Methods: Utilizing a geographically and structurally diverse sample of US hospitals (PREMIER data warehouse, Inc.) we examined the use of ICR using detailed administrative data from January 2007 to June 2011. Patients with an ICD-9 principal diagnosis of myocardial infarction (MI) or heart failure (HF), or with a procedure code for coronary artery bypass surgery (CABG), valve (V) surgery, or percutaneous coronary intervention (PCI) were included. Any patient with ≥ 1 service code for ICR was considered to have received ICR. Results: We evaluated 1,343,537 qualifying admissions from 458 hospitals. The overall ICR utilization rate was 20.8%. ICR utilization was highest in patients with surgical procedures with 45.5%, 37.0%, 40.7% for CABG, V, CABG+V, with rates of 23.7%, 31.3%, 23.7%, 15.6%, and 10.6% for elective PCI, urgent PCI, MI + PCI, MI alone, and HF respectively. Of 458 hospitals, 223 (49%) hospitals provided any ICR, with a median (10-90%) hospital ICR rate of 18.8% (0.06% - 74.1%). Hospitals in urban areas had significantly higher rates of ICR compared to hospitals in rural areas (30.1% vs. 18.6%) as did hospitals with presence of interventional services (surgical services: 31.5% vs. 20.2%, p = 0.006; PCI services: 30.3% vs. 14.7%, p =0.003). Conclusions: There appears to be substantial variation in the delivery of ICR across US hospitals. Less than half of hospitals with cardiac patients provide ICR and only a minority of patients ever receives ICR. This substantial gap in the secondary prevention of heart disease appears to warrant further investigation and intervention.