Early Cardiac Rehab to Reduce Heart Failure Readmissions

Abstract

Background The Centers for Medicare and Medicaid Services (CMS) initiated Cardiac Rehab (CR) coverage for heart failure (HF) patients in 2014. Coverage is limited to HF patients who meet specific criteria. Carilion Clinic, a not-for-profit, integrated healthcare organization composed of seven hospitals in Virginia, has attempted to bridge a gap in service for this patient population by providing an 8 session free CR program. This program, which was made available prior to 2014, is accessible to patients with a HF diagnosis. Objectives The aim of the 8-session free CR program for HF patients is to improve the health of this population and reduce readmissions. By providing monitored exercise sessions, education, and reinforcement of learned materials, patients are encouraged to become knowledgeable and responsible partners in their own healthcare. The 8-session program, which consists of rehab sessions twice weekly for one month, allows for early identification and intervention when problems present. Methods This IRB-approved study used a retrospective quasi-experimental comparison group design incorporating Epic Electronic Medical Record analysis for HF patients discharged between March 2013 and December 2017. Early CR attendance (within six weeks of discharge from the hospital) and readmission rates were evaluated in this study. HF patients who attended CR monitored, CR unmonitored, and the free 8 session program were included. A chi-square test was used to compare the readmission rates of patients who attended early CR and those who did not. The treatment group was identified as HF patients who had attended at least one CR visit within the first 6 weeks following discharge. The comparison group was identified as all HF patients who had not been admitted to the hospital during the previous one-year period, were discharged to home/self-care, and did not attend CR within six weeks of being discharged from the hospital. 30-day and 6-week readmission rates were compared between the treatment and comparison groups. Results Out of 8,613 HF patients, 205 (2.4%) attended at least one session of CR within six weeks post discharge. Readmission rates for comparison group versus treatment group were: 2.7% versus 1.0% for 30-day readmission for HF (p=0.13); 14% versus 5.9% for 30-day all-cause readmission (p Conclusions Statistically significant study results support early access to CR in reducing re-hospitalization rates. Study limitations include unbalanced sample sizes which increased variance and lowered statistical power, potential bias due to exclusion of mortality outcomes, and operationalization of CR as attendance to only one session. Current CMS criteria does not permit early access to CR and limits enrollment to a specific sub-group of this patient population. Future studies are needed with designs that further explore the impact of CR on HF readmissions. Based on the results of this study, CMS and health care systems may consider implementation of early unrestricted access to CR with the aim of improving the health of this patient population and reducing re-hospitalization rates.