While patients with heart failure with reduced ejection fraction (HFrEF) can improve cardiorespiratory fitness and other outcomes through participation in cardiac rehabilitation (CR), less than 3% of eligible Medicare beneficiaries end up participating. A newly published article in JCRP, "Cardiac Rehabilitation Use After Heart Failure Hospitalization Associated With Advanced Heart Failure Center Status," set out to investigate the relationship between HFrEF patients that are hospitalized at advanced Heart Failure Centers (HFCs) and participation in CR. For the purpose of this article, an advanced HFC is a center that offers heart transplantation and/or ventricular assist device (VAD) implantation services.

The author group used Medicare administrative claims for patients with HFrEF from 2018 to 2019 to investigate this topic along with data from the American Hospital Annual Survey from 2008 – 2018 and the Distressed Community Index (DCI) from the American Community Survey to look at acute care center characteristics and regional variability in well-being.

The Medicare claims showed 134,392 patients with heart failure that were hospitalized at 3987 acute care hospitals. Based on the data analyzed, only 4.8% of hospitals can be classified as advanced HFCs, and these centers are more likely to be teaching hospitals, have a larger bed size, be non-profit, and have an affiliated CR program than the average hospital. While only a small number of hospitals from the total study group were categorized as advanced HFCs, 20.6% of the total patient population (29,487 individuals) were hospitalized at a center meeting these criteria. The analysis also showed that the patients hospitalized at advanced HFCs are less likely to be female, of an advanced age, of Hispanic race/ethnicity, have a higher score on the Charleston Comorbidity Index, be from communities with higher levels of distress, and from the Midwest or South census regions. These results align with existing knowledge that women and socioeconomically disadvantaged people are less likely to participate in CR. The author group note that expanding access to advanced HFCs may lead to an increase in CR participation for these populations.

The results of the analysis showed that only 3.0% of patients that attended a non-advanced HFC attended one or more session of CR within a year of discharge from hospitalization, while 6.4% of the patient population that were hospitalized at an advanced HFC attended at least one session of CR within a year of discharge. The author group notes that the increased participation in CR for patients at advanced HFCs could be due to the availability of providers with specialized knowledge of HF care guidelines and best practices, but more investigation is needed to confirm this theory. Ultimately, the authors note that the underlying pathways and practices at advanced HFCs should be further studied so these strategies can be implemented across all acute hospitals to increase CR participation and ultimately improve outcomes for heart failure patients.

The full article, "Cardiac Rehabilitation Use After Heart Failure Hospitalization Associated With Advanced Heart Failure Center Status," can be viewed by accessing JCRP through the AACVPR member portal on the AACVPR website.

Article Authors: Michael P. Thompson, PhD; Hechuan Hou, MS; Max Fliegner, BA; Vinay Guduguntla, MD; Thomas Cascino, MD, MSc; Keith D. Aaronson, MD; Donald S. Likosky, PhD; Devraj Sukul, MD, MSc; Steven J. Keteyian, PhD