Is 70% Achievable? Hospital-Level Variation in Rates of Cardiac Rehabilitation Use Among Medicare Beneficiaries

Authors

Quinn R Pack
Taylor Keys
Aruna Priya
Penelope S Pekow
Steven J. Keteyian, Henry Ford HealthFollow
Michael P Thompson
Thomas D'Aunno
Peter K Lindenauer
Tara Lagu

Recommended Citation

Pack QR, Keys T, Priya A, Pekow PS, Keteyian SJ, Thompson MP, D'Aunno T, Lindenauer PK, and Lagu T. Is 70% Achievable? Hospital-Level Variation in Rates of Cardiac Rehabilitation Use Among Medicare Beneficiaries. JACC Adv 2024; 3(11):101275.

Document Type

Article

Publication Date

11-1-2024

Publication Title

JACC Adv

Abstract

BACKGROUND: Despite national goals to enroll 70% of cardiac rehabilitation (CR)-eligible patients, enrollment remains low.

OBJECTIVES: The purpose of this study was to evaluate how the treating hospital influences CR enrollment nationally.

METHODS: We included Fee-for-Service Medicare beneficiaries aged ≥66 years who were hospitalized for acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or heart valve repair/replacement. We examined: 1) a risk-standardized model to assess comparative hospital rates; 2) a linear regression model to identify hospital factors associated with rates of risk-standardized CR; and 3) a hierarchical generalized linear model to calculate the hospital median OR.

RESULTS: At 3,420 hospitals, we identified 264,970 eligible patients. A minority of hospitals (n = 1,446; 38%) performed cardiac surgery, but these hospitals cared for the majority (n = 242,875; 92%) of all eligible patients. Subsequent analyses were limited to these hospitals. The median risk-standardized CR enrollment rate was low (22%) and varied 10-fold across hospitals (10th, 90th percentile: 3%, 42%). Factors associated with higher hospital performance were Midwest location, higher number of hospital beds, directly affiliated CR program, and <1 mile distance between the hospital and closest CR facility. The national hospital median OR was 2.1.

CONCLUSIONS: The treating hospital plays a key role in facilitating CR enrollment after discharge. Fewer than 1% of U.S. hospitals achieved a risk-standardized CR enrollment rate of >70%. Hospitals with cardiac surgery capability care for more than 90% of all CR-eligible patients and may be a logical place to focus improvement efforts.

PubMed ID

39741644

Volume

3

Issue

11

First Page

101275

Last Page

101275