Cardiac Rehabilitation After Acute Myocardial Infarction

Study Questions:

What are the rates of enrollment in cardiac rehabilitation, as well as completeness of participation among older adults, and differences in characteristics between patients who did and did not participate after referral?

Methods:

The investigators linked clinical data from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines to Medicare claims for patients 65 years or older presenting with acute myocardial infarctions (AMIs) from January 2007 through December 2010 (n = 74,798). Cardiac rehabilitation referral was captured as part of the registry data collection form. Program attendance was identified using Current Procedural Terminology codes (93797 and 93798) and Healthcare Common Procedure Coding System codes (G0422 and G0423) in Medicare claims. Baseline characteristics and treatment variables were compared using χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous variables.

Results:

From 2007 to 2010, the investigators identified 58,269 older patients eligible for cardiac rehabilitation after AMI and who met inclusion criteria. Of these, 36,376 (62.4%) were referred to cardiac rehabilitation at the time of hospital discharge. Of those referred, 11,862 (32.6%) attended at least one session within the next year. Among those not initially referred, 1,795 (8.2%) attended at least one session. In total, 13,657 of 58,269 (23.4%) AMI patients attended one or more cardiac rehabilitation sessions; 3,175 (5.4%) completed 36 sessions or more. Compared with those who did not participate, patients who participated in at least one session of cardiac rehabilitation were younger and more likely to be male, white, nonsmokers, and to have fewer baseline comorbidities. Presentation with ST-segment elevation MI was more common among participants.

Conclusions:

The authors concluded that the rate of participation in cardiac rehabilitation is low in the United States, even among patients with AMI who are referred.

Perspective:

This analysis reports rates of participation in cardiac rehabilitation in the United States, and identifies opportunities to improve the use of cardiac rehabilitation by older adults. Quality improvement efforts should focus not only on increasing referral rates, but also on addressing barriers to attending rehabilitation sessions, such as travel distance, copayments, and lack of coordination between inpatient and outpatient clinicians. Alternative methods of providing cardiac rehabilitation, such as home-based and community programs, may need to be developed to improve cardiac rehabilitation participation rates.

Clinical Topics: Acute Coronary Syndromes, Geriatric Cardiology, Prevention

Keywords: Acute Coronary Syndrome, Ataxia, Geriatrics, Medicare, Myocardial Infarction, Primary Prevention, Quality Improvement, Referral and Consultation, Rehabilitation, Treatment Outcome


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