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Few Older Patients Get Needed Cardiac Rehab

January 17, 2020

By Lisa Rapaport

(Reuters Health) - Only about one in four patients on Medicare receive cardiac rehabilitation recommended to help them recover from events like a heart attack or coronary bypass surgery, a U.S. study suggests.

Among those who do go to cardiac rehab, most don't complete enough sessions to get the maximum benefit, the study also found.

"Every cardiac rehabilitation session that a patient doesn't use is a missed opportunity for them to improve their health," said lead study author Matthew Ritchey of the U.S. Centers for Disease Control and Prevention in Atlanta.

"Participation in a cardiac rehabilitation program has been shown to reduce the risk of death from any cause and from heart disease-related causes, as well as decrease hospital readmissions and improve functional status, quality of life, and mood," Ritchey added.

For the study, researchers examined data on 366,103 people who had cardiac events that should be followed by rehab for optimal outcomes. All had insurance coverage through Medicare.

Overall, just 89,327 people, or about 24%, went to any cardiac rehab at all.

Among those who did go to rehab, participants completed about 25 sessions, on average. Only 27% had at least the 36 sessions recommended for optimal benefits, researchers report in Circulation: Cardiovascular Quality Outcomes.

Women were 9% less likely to go to cardiac rehab than men, the study found.

Compared with white patients, black patients were 30% less likely to get cardiac rehab, while Hispanic patients were 37% less likely and Asian patients were 20% less likely.

The sickest patients also appeared least likely to get rehab. Compared to people with no more than two chronic health problems, individuals with at least seven different medical issues were 35% less likely to go to cardiac rehab.

Cardiac rehab also became less likely with advancing age. Compared to people ages 65 to 74, those ages 75 to 84 were 7% less likely to go to cardiac rehab and individuals 85 and older were 43% less likely to go.

One limitation of the analysis is that researchers relied on data used for medical billing, and they lacked detailed medical information on individual patients. Researchers also didn't know whether patients received referrals for cardiac rehab, making it unclear how many people missed out on it because they were not told to go.

"Cardiac rehab remains underutilized despite its unequivocal salubrious benefits," said Dr. Hani Jneid, director of Interventional Cardiology at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston.

"We need additional work to identify the barriers to implementation and more education of patients and healthcare providers," Jneid, who wasn't involved in the study, said by email. "A comprehensive cardiac rehab is best to complement an exercise-based regime, and if institutional rehab is not feasible, home-based rehab should also be considered."

SOURCE: Circulation: Cardiovascular Quality Outcomes, online January 14, 2020.

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