Cardiac Rehab Participation Is Higher For Heart Failure Patients Treated In Facilities That Offer Advanced Heart Failure Therapies

Document Type

Conference Proceeding

Publication Date

9-1-2022

Publication Title

Journal of Cardiopulmonary Rehabilitation and Prevention

Abstract

Introduction: Participation in cardiac rehabilitation (CR) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) lags far behind other qualifying conditions. Hospitals performing transplant/VAD may be more likely to realize the benefits of CR and exercise given that CPX testing is used to determine the needed for advanced therapies. Therefore, established relationships between advanced HF and CPX/CR providers may lead to more frequent participation in CR programs for patients with HFrEF. Purpose: To evaluate the effect of admission to a hospital with advanced HF therapies on CR participation in Medicare beneficiaries hospitalized with HFrEF. Design: A retrospective cohort study of a 20% sample of Medicare beneficiaries hospitalized with HFrEF between 01/01/2008 and 12/31/2019. Methods: Beneficiaries were excluded if they died or had any other CR qualifying condition during the calendar year. The primary exposure was admission to a hospital with advanced HF therapies (yes versus no), which was defined based on the presence of ICD-9/10 procedure codes for heart transplantation or ventricular assist device implantation in the admitting hospital. Participation in CR (yes versus no) was defined using CPT codes (93797, 93798, G0424, G0423) in professional claims data during the same calendar year as the hospitalization. Multivariable logistic regression was used to evaluate the effect of admission to a hospital with advanced HF therapies on CR participation, adjusting for patient factors and admitting hospital. Results: Overall, a total of 6,507 of 294,701 (2.2%) Medicare beneficiaries hospitalized with HFrEF participated in CR during the study period. A quarter of the beneficiaries were hospitalized at a hospital with advanced HF therapies (74,661/294,701) and among these patients CR participation was significantly higher when compared to non-advanced HF hospitals (3.6% vs. 1.8%, p < 0.001). Beneficiaries treated at advanced HF hospitals were more likely to be male, younger in age, racial/ethnic minority, non-dually eligible for Medicare and Medicaid, and present with more comorbid conditions. Adjusting for these patient factors, CR participation rates were 1.9-percentage points (pp) higher for patients hospitalized in advanced HF facilities relative to non-advanced HF facilities (3.6% vs. 1.7%, p < 0.001). Furthermore, the gap in CR participation rates between admission to advanced HF and non-advanced HF hospitals increased over time, from 1.1-pp in 2008 (2.0% vs. 0.9%) to 2.8-pp in 2019 (5.3% vs. 2.5%). Conclusions: The overall rate of participation in CR among Medicare beneficiaries hospitalized with HFrEF is alarmingly low. CR participation is significantly higher for patients treated in hospitals offering advanced HF therapies, and this disparity increased over time. Identifying structural factors that contribute to or restrict CR participation for patients with HFrEF may help national quality improvement efforts.

Volume

42

Issue

5

First Page

E59

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