Cardiac Rehabilitation Adherence Rates Vary Widely Across Facilities

Document Type

Conference Proceeding

Publication Date

8-22-2025

Publication Title

J Cardiopulm Rehabil Prev

Keywords

aortic valve replacement, cardiovascular disease, conference abstract, controlled study, coronary artery bypass graft, coronary artery bypass surgery, female, heart rehabilitation, hospital discharge, human, major clinical study, male, medical fee, medicare, patient compliance, percutaneous coronary intervention, retrospective study, therapy, transcatheter aortic valve implantation, United States

Abstract

Introduction: Patients participating in cardiac rehabilitation (CR) are typically prescribed 36 sessions following a qualifying cardiovascular event. Adherence to this 36-session recommendation is considered a quality indicator for CR facilities. However, the variation in adherence rates across CR facilities has not been well studied. Purpose: To describe and evaluate facility-level rates of adherence to CR session recommendations among Medicare beneficiaries following a recent cardiovascular procedure. Design: Retrospective analysis of claims data for Medicare fee-for-service Part A/B beneficiaries who were discharged alive following an inpatient coronary artery bypass grafting, surgical aortic valve replacement, percutaneous coronary intervention, or transcatheter aortic valve replacement between July 2016 and December 2018. Methods: Beneficiaries were attributed to CR facilities based on the national provider identifier listed on their CR claims. Facilities with fewer than 20 attributed cases were excluded. The primary outcome was CR adherence (yes vs. no), defined as completing at least 36 sessions within one year of hospital discharge. Hierarchical logistic regression was used to estimate risk-adjusted facility-level adherence rates, adjusting for patient demographics, procedure type, clinical complexity, and clustering of patients within facilities. The cluster-level variance estimate was used to calculate the median odds ratio, or the median increase in odds of CR adherence when comparing similar patients from two different facilities. Bivariate analyses compared risk-adjusted adherence rates across facility characteristics, including urbanicity (rural, small town, suburban, urban), facility volume quartiles, and U.S. Census region (Northeast, South, Midwest, West). Results: Among 183,888 beneficiaries who attended at least one CR session across 2,242 facilities, 53,558 (29.1%) completed all 36 sessions, with a mean of 25.6 sessions attended (standard deviation [SD] = 12.4). Risk-adjusted facility-level adherence rates ranged from 0% to 92.1%, with a median of 33.1% (interquartile range 18.8%-45.2%) and a mean of 32.6% (SD = 17.7%). After adjusting for patient factors, the median odds ratio for CR adherence between facilities was 2.34 (95% CI: 2.27, 2.24), which indicates a moderate to high clusterlevel effect of CR facilities on adherence rates. There were no significant differences in adherence rates based on facility degree of urbanicity or volume. However, adherence varied by region, with the highest rates observed in the South (37.6%), followed by the West (31.6%), Northeast (29.7%), and Midwest (29.6%) (p<0.001). Conclusions: In addition to a generally low (29%) rate of adherence to the prescribed 36 CR sessions, substantial variation exists across CR facilities, suggesting opportunities for improvement. Identifying practices that promote or hinder CR adherence at both high- and low-performing centers or practices that can be used to optimize CR session volume for individual patients will be critical for enhancing overall participation and enhancing quality..

Volume

45

Issue

5

First Page

E37

Last Page

E38

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