Abstract
Introduction: Participation in cardiac rehabilitation (CR) is poor, with disparities across patient demographic and clinical subgroups. Lower CR participation and completion rates may be associated with patients residing in socioeconomically distressed communities. Hypothesis: Patients undergoing surgical and percutaneous coronary revascularization living in distressed communities have lower rates of CR participation and completion. Methods: Medicare beneficiaries undergoing coronary revascularization (July 2016-December 2018) were identified using 100% Medicare claims data. The primary exposure was the quintile of distressed community index (DCI), with 1st and 5th quintiles representing the least and most distressed communities, respectively. CR participation and completion were defined as attending ≥1 session and attending 36 sessions within 1 year of discharge based on CPT codes in outpatient files. Multivariable logistic regression was used to evaluate the relationship between beneficiary DCI quintile and CR participation and completion. Results: Among 414,730 beneficiaries, 23.4% lived in the 1st DCI quintile and 16.4% lived in the 5th quintile. Patients in the 5th DCI quintile tended to be younger, non-white, dual eligible for Medicare/Medicaid, and more comorbid. Overall, 155,872 (37.6%) patients participated in ≥1 CR session, and 45,591 (29.3%) of those patients completed all 36 sessions. CR participation decreased as DCI quintile increased, with participation 12.0 percentage-points lower in the 5th vs 1st DCI quintile (Table). There were no significant differences in completion of 36 sessions across DCI quintiles. Conclusions: CR participation was significantly lower in more socioeconomically distressed communities, but there were no differences in completion rates. Strategies to reduce disparities in CR participation in distressed communities should focus on barriers to initial enrollment after qualifying events.
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