Objectives

The purpose of this study was to assess temporal trends and factors associated with cardiac rehabilitation (CR) enrollment and participation among Medicare beneficiaries after the 2014 Medicare coverage expansion.

Background

CR improves exercise capacity, quality of life, and clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). In 2014, Medicare coverage for CR was expanded to include chronic HFrEF.

Methods

Among Medicare beneficiaries from quarter (Q) 1 2014 to Q2 2016, 11,696 patients from 14,258 hospitalizations with primary discharge diagnosis of HF were identified. Patients with HF with preserved ejection fraction were excluded. Quarterly CR participation rates among hospitalized HF patients within 6 months of discharge were identified through outpatient administrative claims. The predictors of CR participation were assessed with the use of a multivariable logistic regression model that included patient- and hospital-level characteristics. A secondary analysis to assess participation rates of CR after outpatient encounters for HF was performed.

Results

Overall, only 611 (4.3%) and 349 (2.2%) eligible patients participated CR after primary hospitalization or outpatient visit for HF, respectively. There was a modest, statistically significant increase in CR participation after HF admissions (2.8% in Q1 2014; 5.0% in Q2 2016; p < 0.001) without significant increase after outpatient visits for HF (2.6% to 3.8%; p = 0.21). Younger age, male sex, nonblack race, previous cardiovascular procedures, and hospitalization at hospitals with available CR facilities were all independently associated with CR participation.

Conclusions

CR participation among eligible Medicare beneficiaries with HFrEF was low with minimal increase since 2014 Medicare coverage decision. Sex, race, and institution-dependent variables were independent predictors of CR participation.

中文翻译：

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与心力衰竭医疗保险受益人心脏康复参与相关的时间趋势和因素

目标

本研究的目的是评估 2014 年医疗保险覆盖范围扩大后与医疗保险受益人心脏康复 (CR) 注册和参与相关的时间趋势和因素。

背景

CR 可改善射血分数降低 (HFrEF) 心力衰竭 (HF) 的运动能力、生活质量和临床结果。2014 年，医疗保险对 CR 的覆盖范围扩大到包括慢性 HFrEF。

方法

在 2014 年第 1 季度至 2016 年第 2 季度的医疗保险受益人中，确定了 11,696 名患者，这些患者来自 14,258 次住院，主要出院诊断为 HF。排除射血分数保留的 HF 患者。通过门诊行政索赔确定出院后 6 个月内住院 HF 患者的季度 CR 参与率。使用包括患者和医院级别特征的多变量逻辑回归模型评估 CR 参与的预测因素。进行了一项二级分析，以评估门诊 HF 患者的 CR 参与率。

结果

总体而言，分别只有 611 (4.3%) 和 349 (2.2%) 名符合条件的患者在因 HF 住院或门诊就诊后参与了 CR。HF 入院后 CR 参与率略有统计学显着增加（2014 年第一季度为 2.8%；2016 年第二季度为 5.0%；p < 0.001），但在 HF 门诊就诊后没有显着增加（2.6% 至 3.8%；p = 0.21） . 年龄较小、男性、非黑人种族、既往心血管手术以及在具有可用 CR 设施的医院住院均与 CR 参与独立相关。

结论

自 2014 年医疗保险覆盖决定以来，符合条件的具有 HFrEF 的医疗保险受益人的 CR 参与率很低，增幅很小。性别、种族和机构相关变量是 CR 参与的独立预测因素。