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Study finds cardiac rehab underused among Medicare patients

Nov. 21, 2019, 10:27 AM


by Matt Batcheldor

Cardiac valve surgery patients who participate in a cardiac rehabilitation program have a 34% lower risk of hospitalizations and a 4.2% lower risk of mortality than patients who do not enroll in cardiac rehab in the year after surgery.

Justin Bachmann, MD, MPH

However, fewer than half — 43% — of Medicare patients enroll in rehab, despite most of the potential cost being covered by the program, according to a Vanderbilt study recently published in JAMA Cardiology.

The study’s lead author is Justin Bachmann, MD, MPH, a cardiologist and assistant professor of Medicine, Biomedical Informatics and Health Policy. He said that the study is the first to examine at the national level how many cardiac valve surgery patients use cardiac rehab, a program of supervised exercise, dietary counseling, smoking cessation and other risk-factor management over 36 thrice-weekly sessions.

Bachmann, who is medical director of the Vanderbilt Cardiopulmonary Rehabilitation Program at the Dayani Center, said he has seen the benefit of cardiac rehab first-hand and is inspired by the dedicated work of the exercise physiologists, nurses and other professionals at Vanderbilt.

“Cardiac rehabilitation is as beneficial as any of our major drug therapies, including aspirin and beta blockers,” he said. “In cardiology, we’re often very focused on procedures and drugs. Cardiac rehabilitation is just as important.”

Bachmann studied Medicare claims data to document the low utilization of cardiac rehab. He said the benefits of rehab are well-known, but patients must overcome a number of barriers to enroll — referral, cost, transportation and skepticism among them.

First, a provider must refer them to rehab, and referral rates have room to improve.

Cost can be a major issue. Medicare-eligible patients, who represent most who undergo cardiac valve surgery, qualify for 80% of their care to be covered, potentially leaving hundreds of dollars of cost to the patient and putting it out of reach for some disadvantaged patients. Medicare Advantage plans, Medicare supplements and private insurance vary in how much they cover.

Even if patients obtain coverage, work responsibilities, transportation issues and distance to cardiac rehab centers are major barriers.

One area that is not a barrier is a patient’s ability to complete rehab. Bachmann said the overwhelming majority of patients can safely participate.

“There are very few reasons why a patient should not be referred,” he said. “Even if patients cannot walk, cardiac rehabilitation professionals can find innovative ways for them to exercise, such as upper body ergometers.”

The study’s other Vanderbilt authors are Devin Patel, MD; Meredith Duncan, MA; Ashish Shah, MD; Brian Lindman, MD, MSc; Robert Greevy Jr., PhD; Michael Matheny, MD, MS, MPH; and Matthew Freiberg, MD, MSc.

The research was supported by the Vanderbilt Clinical and Translational Science grant UL1 TR000445 from the National Center for Advancing Translational Sciences at the National Institutes of Health and grant K12HS022990 from the Agency for Healthcare Research and Quality.

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