A new study suggests that participating in a cardiac rehabilitation program after undergoing cardiac valve surgery was linked with a reduction in hospitalizations and lower mortality at one year.
“National guidelines recommend cardiac rehabilitation after cardiac valve surgery, and CR is covered by Medicare for this indication,” the authors wrote. “However, few data exist regarding current cardiac rehabilitation enrollment after valve surgery.”
The paper, published in JAMA Cardiology, was a cohort study of patients undergoing valve surgery in calendar year 2014, with follow-up through 2015. The study included 41,369 Medicare beneficiaries. The authors used logistic regression to evaluate the sociodemographic and clinical factors associated with cardiac rehabilitation enrollment. The outcomes of interest included the association of rehab enrollment with one-year hospitalization (assessed using Andersen-Gill models), and also between enrollment and one-year mortality risk (assessed by Cox regression models).
According to the results, fewer than half of he study patients were enrolled in cardiac rehabilitation programs, and several racial/ethnic groups were less likely to enroll in the programs compared to white patients Asian patients (OR=0.36; 95% CI, 0.28 to 0.47), black patients (OR=0.60; 95% CI, 0.54 to 0.67), and Hispanic patients (OR=0.36; 95% CI, 0.28 to 0.46). Those who underwent concomitant CABG procedures had higher enrollment rates than those without CABG. Enrollment in cardiac rehabilitation programs was also associated with fewer hospitalizations within a year of discharge (HR=0.66; 95% CI, 0.63 to 0.69), and an absolute decrease of 4.2% in risk for one-year mortality (HR=0.39; 95% CI, 0.35 to 0.44) following adjustment.
“Fewer than half of Medicare beneficiaries undergoing cardiac valve surgery enroll in CR programs, and there are marked racial/ethnic disparities among those that do,” the researchers wrote in their conclusion. “Cardiac rehabilitation is associated with decreased 1-year cumulative hospitalization and mortality risk after valve surgery. These results invite further study on barriers to cardiac rehab enrollment in this population.”
— Arden Barry (@ArdenBarry) October 24, 2019
I can tell you why cardiac rehab is so poorly utilized. It’s a logistical nightmare. The hours at some cardiac rehab places is 730 am – 1130 am. No evenings. Reimbursement is terrible so there is no incentive for hospitals to improve access. #cardiacrehab https://t.co/1xifoXtPOA
— DrLatina (@DoctorLatina) October 24, 2019
Lucky to have colleagues like @drwhiteson for my post-cardiac procedures! Association of Cardiac Rehabilitation With Decreased Hospitalization and Mortality Risk After Cardiac Valve Surgery https://t.co/jiK5H27jZH
— Eric Goldberg, MD (@DiagnosisMD) October 24, 2019
Cardiac #Rehab (CR) is associated with decreased 1-year cumulative hospitalization & mortality after #valve surgery; yet, fewer than half of #Medicare beneficiaries post-valve surgery enroll in CR. Marked racial/ethnic disparities noted in those that do. https://t.co/i63CkDj5Ng pic.twitter.com/H1kRzrOxjR
— George Mensah, MD (@NHLBI_Translate) October 23, 2019