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 Despite benefits from rehabilitation such as better quality of life
and lower rates of rehospitalization, patients may not attend these
sessions because of issues related to insurance, costs and access to
a rehab facility, the study authors report in the Journal of the
American College of Cardiology.
Efforts to get doctors to increase their referrals of patients for
cardiac rehab have worked, the authors write, but more needs to be
done to make sure patients attend the sessions.
"The use of cardiac rehabilitation after coronary stenting carries
the strongest recommendation in our clinical practice guidelines,"
said lead author Dr. Devraj Sukul of the University of Michigan in
Ann Arbor.
"Unfortunately, the use of cardiac rehabilitation among eligible
patients remains low," he told Reuters Health by email.
Sukul and colleagues analyzed data on more than 42,000 Michigan
patients who underwent percutaneous coronary intervention (PCI), a
common procedure to clear a blocked heart artery that typically
includes placement of a tiny tubular stent to keep the blood vessel
open. Using two databases of medical and health insurance records,
researchers tracked patients who received care at one of 47 Michigan
hospitals between 2012 and 2016, noting who was referred to cardiac
rehab, who attended and what factors may have influenced their
participation.
The study team found that 30,075 patients were discharged alive to
their homes with a referral for cardiac rehab, and 8,000 attended at
least one session within 90 days after discharge. People were more
likely to attend if they had an "acute" reason for getting PCI, such
as certain types of heart attack. And those who had other health
problems, such as diabetes and peripheral artery disease, were less
likely than others to attend rehab.
In addition, patients covered by Medicare Fee-For-Service insurance
were less likely to attend cardiac rehab than those covered by
private Blue Cross Blue Shield of Michigan plans. Among all the
patients with Medicare, those also covered by Medicaid, the
state-run insurance plan for the poor, were less likely to attend a
session.
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Geography played an interesting role as well, the researchers note.
The distance from the center of a patient's home ZIP code to the
nearest cardiac rehab session didn't make a difference in who was
likely to attend rehab. But if the cardiac rehab location was more
than two miles from the site where the PCI procedure took place, a
patient was less likely to attend cardiac rehab.
"We found it interesting that there were a diverse set of factors
associated with patients ultimately attending cardiac
rehabilitation," Sukul said. "This suggests that multi-faceted
strategies, such as insurance redesign, may need to be tested and
implemented to improve cardiac rehabilitation use."
"Ideally, cardiac rehab would be provided without cost to all
patients who qualify regardless of financial ability," said Dr.
Ellen Keeley of University of Florida Health in Gainesville, who
wasn't involved in the study.
Keeley and colleagues run a clinic that evaluates heart attack
patients after hospital discharge, which includes a conversation
about cardiac rehab. Patients are more likely to enroll after
hearing details about what it involves, such as exercise, nutrition
counseling and smoking cessation, she noted.
"I think the one-on-one aspect - and the fact they have been out of
the hospital for about one week - allows them to ask a lot of
questions in a relaxed fashion, and then they see that this type of
program has a lot to offer them," Keeley said by email.
Making cardiac rehab more accessible through "pop-up" sites that use
space in a community center, as well as mobile units and
telemedicine, could help those who live far away, she added.
"Even if a patient cannot attend all the sessions due to finances or
distance or both, I encourage them to at least attend one or two
sessions," she said. "They can learn a significant amount about diet
and exercise and gain pointers on how to create their own program at
home."
SOURCE: https://bit.ly/31JTjak Journal of the American College of
Cardiology, online June 17, 2019.
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