Underutilized cardiac rehab can boost long-term survival of patients

by | May 16, 2012

From: Medpage Today

Emerging data show that, in patients who have post-MI rehabilitation, long-term survival may be boosted by as much at 59% compared with patients who are not prescribed rehabilitation.

But the benefit of cardiac rehabilitation is often never realized because utilization of rehab programs is low, according to Steven W. Lichtman, EdD, president of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and director of cardiopulmonary outpatient services at Helen Hayes Hospital in West Haverstraw, N.Y.

A 2007 study published in Circulation: Journal of the American Heart Association drove home that point, Lichtman explained in a presentation at EuroPRevent 2012.

“The study analyzed Medicare claims data from 267,427 patients hospitalized for MI and found that only 13.9% of those patients had cardiac rehabilitation,” he said.

After coronary artery bypass grafting (CABG), the utilization rate was 31%, but it varied widely by region, from a low of 7% in Idaho to a high of 53% in Nebraska.

Lichtman said that was a wake-up call for the AACVPR, which responded by organizing support for implementation of performance measures and national quality guidelines for cardiac rehabilitation.

That same year — 2007 — the association enlisted the American College of Cardiology and the American Heart Association as co-sponsors of performance measures for cardiac rehabilitation and secondary prevention services.

Early initiation of a rehabilitation program is essential for achieving maximum benefit, Lichtman said, so the performance measures stipulate that patients hospitalized for a qualifying event should be referred to early outpatient cardiac rehab prior to discharge.

Qualifying events — those for which Medicare has approved payment for rehabilitation — include MI, chronic stable angina, CABG, percutaneous coronary interventions, valve surgery, and heart transplantation.

An analysis of crude 5-year data from 601,099 acute coronary syndrome patients, published by the Journal of the American College of Cardiology in 2009, revealed a 59% relative risk reduction in mortality for patients who had cardiac rehabilitation.

In 70,040 propensity-based matched pairs, the mortality rate at 5 years was 16.3% in cardiac rehabilitation patients versus 24.6% among those who did not have rehab, for a relative risk reduction of 34%.

Additionally, cardiac rehabilitation programs “are a low-cost, low-tech solution that per dollar spent is more effective than bypass surgery,” Lichtman said.

Currently, he said, “cardiac rehabilitation is reimbursed at an average of $65 per session, but it is valued at $100 a session.”

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