Few heart failure patients receive critical care, according to AHA News.
Few heart failure patients receive critical care, according to AHA News.
Medicare Coverage for Cardiac Rehabilitation: A Vital but Underutilized Resource for Heart Failure Patients
Medicare coverage for cardiac rehabilitation for heart failure patients has been expanded for almost a decade, and medical guidelines strongly recommend it. However, a recent study has found that many eligible individuals are not accessing this important resource. Only 1 in 4 people in a nationwide registry received cardiac rehabilitation referrals after being hospitalized for heart failure with reduced ejection fraction. Among them, only about 1 in 25 actually participated in a rehabilitation program1.
The study, published in the journal Circulation: Heart Failure, highlights the persisting disparities in accessing cardiac rehabilitation. Certain groups, such as older individuals, Black Americans, those with multiple health problems, and individuals living in rural areas, are less likely to be referred for cardiac rehabilitation2. These disparities are concerning as cardiac rehabilitation, which includes exercise training and healthy lifestyle education, has been proven to improve quality of life, increase exercise levels, and reduce the risk of heart failure hospitalization or death from any cause3.
Dr. Ambarish Pandey, a senior author of the study and a cardiologist at UT Southwestern Medical Center, emphasizes the importance of overcoming biases regarding older patients and those with frailty issues4. Patients who are older are often considered too frail for cardiac rehabilitation, despite evidence suggesting that they may benefit even more from the program than their healthier counterparts. Additionally, there may be conscious and subconscious biases related to race that contribute to lower referral rates for Black patients5.
The Centers for Medicare and Medicaid Services expanded coverage for cardiac rehabilitation in 2014, targeting people with chronic, stable heart failure with reduced ejection fraction who remain out of the hospital for six weeks6. However, despite the expansion of coverage, only 26% of eligible patients were referred to cardiac rehabilitation, and only 4% of them actually participated, attending an average of seven sessions7. These numbers indicate a significant gap in utilizing this potentially life-saving resource.
The American Heart Association estimates that 6.7 million adults in the United States are living with heart failure8. Given the rising numbers of heart failure cases, it is crucial to ensure that cardiac rehabilitation is accessible to all eligible patients. The heart failure guidelines from the American Heart Association and the American College of Cardiology emphasize the inclusion of cardiac rehab as part of a patient’s post-discharge care plan9.
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To address the barriers to access, Dr. Steven Keteyian, the director of preventive cardiology at Henry Ford Hospital, suggests the use of telehealth options for patients who lack transportation or live in rural areas with limited rehab programs10. Additionally, good doctor-patient communication is essential to ensure patients are aware of and have access to cardiac rehabilitation11. Physicians and patient care teams should have a frank discussion with patients, addressing their specific needs and helping them navigate the essentials of disease management. For example, if transportation is challenging, alternative solutions, such as coming to rehab in person once a week and following a structured program at home, can be explored12.
In conclusion, cardiac rehabilitation is a vital component of post-hospitalization care for heart failure patients13. Despite the proven benefits, many eligible individuals are not receiving the referrals or participating in these programs. It is crucial for healthcare providers to proactively inform and offer cardiac rehabilitation to all heart failure patients14. By addressing biases, implementing telehealth options, and improving doctor-patient communication, more individuals can benefit from this life-enhancing resource.
References
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Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
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Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
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Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
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Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
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Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
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Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
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Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
-
Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
-
Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
-
Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
-
Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
-
Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
-
Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎
-
Mulcahy, L. (Year, Month Day). Medicare coverage for cardiac rehab still falling short for heart failure. American Heart Association News. Retrieved from link.↩︎