Less than 10% of adults with heart failure get cardiac rehab despite Medicare expansion
Research Highlights:
- In 2014, Medicare expanded coverage for cardiac rehabilitation to include adults with heart failure with reduced ejection fraction, given studies showing cardiac rehab can improve physical function and reduce death and hospitalizations.
- In the three years after this Medicare coverage began (2014-2017), enrollment in cardiac rehab among Medicare beneficiaries with heart failure increased from 4.30% to 5.54%, a relative annual increase of about 10%; that was nearly double the increase the six years prior to the expansion (2008-2014), when enrollment rose from 3.30% to 4.30%, a relative annual increase of about 5%.
- Although the addition of Medicare coverage increased enrollment, researchers said less than 10% of eligible adults with heart failure take part in cardiac rehab and other interventions should be undertaken to increase enrollment in cardiac rehab.
(NewMediaWire) -
Heart failure occurs when the heart isn't pumping as well as it should to deliver oxygen- and nutrient-rich blood to cells and organs throughout the body. Heart failure with reduced ejection fraction means the ejection fraction, or how much blood the left ventricle pumps with each contraction, is at or below 40%. Normal ejection fraction is considered 50% to 70%.
According to the
"There are nearly 1.1 million hospitalizations for heart failure annually, making it one of the most common reasons for hospital admission among people 65 years of age or older, whose health care costs are primarily covered by Medicare," said study author
There is strong evidence that a supervised exercise regimen, like the physical activity plan integrated into cardiac rehab programs, can prevent death, reduce hospitalization and improve physical function in adults with heart failure. However, less than 3% of eligible patients had enrolled in cardiac rehab prior to 2014, when the
To determine what, if any, benefit the expanded Medicare reimbursement had among patients with heart failure with reduced ejection fraction, researchers analyzed a sample of Medicare claims data from 2008 to 2017, prior to and after the 2014 CMS ruling. They identified 849,054 Medicare fee-for-service beneficiaries, 65 years of age and older, who had heart failure with reduced ejection fraction. The analysis found:
- Nearly 34,200 people (about 4% of the population studied) attended cardiac rehabilitation during the study period.
- Analysis of the time period prior to the Medicare reimbursement change, from 2008 to 2014, found that cardiac rehabilitation use increased slowly, from 3.30% to 4.30%, about a 5% relative increase year-to-year.
- After the 2014 Medicare expansion to cover cardiac rehab for people with heart failure with reduced ejection fraction, rates of cardiac enrollment went from 4.30% in 2014 to 5.54% in 2017, with a relative increase of about 10% year-to-year.
- Overall, although the absolute enrollment rate in cardiac rehabilitation remained low, expanding Medicare coverage in 2014 was associated with a notable increase in the use of cardiac rehab among adults with heart failure.
"Despite clear benefits of cardiac rehabilitation in preventing death, reducing hospitalizations and improving physical ability, cardiac rehabilitation is used by very few. Based on the current data, more than 90% of people with heart failure will not receive a treatment that could improve their health and survival," Guduguntla said. "Our study highlights insurance coverage as one important factor that impacts increasing cardiac rehabilitation participation. Future work should aim to identify and address all barriers to enrollment and find creative solutions to this complex problem."
"Enacting public policies is one effective way to address the enrollment barriers that prevent the majority of people with heart failure from benefitting from cardiac rehabilitation," said
Thomas noted CMS participation criteria is also a significant barrier to cardiac rehabilitation for people with heart failure. "CMS criteria requires that patients wait at least 6 weeks after a heart failure hospitalization to participate in cardiac rehabilitation," he said. "Studies show that any delay in starting cardiac rehabilitation after hospitalization decreases participation rates and worsens patient outcomes."
A limitation of the study is the lack of information about cardiac rehabilitation by location, race/ethnicity and other demographic factors about individuals. Guduguntla said this information is important to fully understand why the use of cardiac rehab is so low.
"Recent literature reviewed demographic information at a high level and suggests there are disparities in cardiac rehabilitation use across race/ethnicity and geographic location," Guduguntla said. "We are pursuing further analyses of the specific impact of Medicare coverage expansion for cardiac rehabilitation among people from different social and ethnic groups."
Co-authors are Hechuan Hou, M.S.;
The researchers reported no funding for this study.
Additional Resources:
- Multimedia is available on the right column of the news release link https://newsroom.heart.org/news/less-than-10-of-adults-with-heart-failure-get-cardiac-rehab-despite-medicare-expansion?preview=2a796e64febd431050a6d0ec38c1183f
- AHA Scientific Session 2021 Online Program Planner
- Bipartisan legislation to increase access to cardiac and pulmonary rehabilitation programs introduced in the
House of Representatives |American Heart Association - Ask Lawmakers to Increase Access to Cardiac Rehabilitation Programs! (yourethecure.org).
- Living with Heart Failure and Managing Advanced HF
- Treatment Options for Heart Failure
- Follow AHA/ASA news from the meeting on Twitter @HeartNews #QCOR21
Statements and conclusions of study authors that are presented at
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