Cardiac Rehabilitation and Heart Failure: An Opportunity to Improve Care

Cardiac rehabilitation improves functional capacity and quality of life in patients with heart failure with reduced ejection fraction. In 2014, the Centers for Medicare and Medicaid Services expanded coverage for cardiac rehabilitation among clinically stable patients. However, current referral patterns and utilization rates are unknown.

At #AHA22, we had the pleasure of presenting our work evaluating temporal trends and predictors of cardiac rehabilitation referral and associated outcomes as ascertained through the AHA’s Get With The Guidelines®–Heart Failure registry. We first evaluated referral to cardiac rehabilitation over the past 10 years. We found that while referral rates increased from 2010-2020 and have risen since the 2014 CMS coverage expansion, overall referral rates are still low. Only 1 in every 4 eligible patients is referred to cardiac rehabilitation, and patients less likely to be referred are more likely to be older, of Black race, and have a greater burden of medical comorbidities. We then evaluated cardiac rehabilitation participation rates among participants with available Medicare data. Only 4% of patients who were referred participated in a single session of cardiac rehabilitation, and the median number of sessions attended per participant was low. Finally, in adjusted analyses, there were no significant differences in 1-year mortality or readmission among patients referred versus not referred to cardiac rehabilitation.

Our study highlights the contemporary utilization and referral patterns of cardiac rehabilitation in patients with heart failure, demonstrating that both referral and utilization rates are low. Future investigations should center on improvements in patient and clinician understanding of the role of cardiac rehabilitation in heart failure as well as novel approaches to ease barriers to participation in cardiac rehabilitation.