By Denise Williams | News & Views

Just over one year ago, stakeholders supporting the cardiac rehabilitation (CR) community swarmed online to generate ideas and strategies in support of the Million Hearts Collaborative. A partnership between the Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS), the project aims to prevent heart attacks, strokes and other cardiovascular events through greater awareness of CR. Another objective is to increase participation in CR to include at least 70 percent of eligible patients.  

Considering the key role CR plays in achieving the Million Hearts mission and with the understanding that this resource is heavily underutilized in this country, AACVPR teamed up with the agencies to organize the three-day virtual brainstorming session. Representatives from across the spectrum—patients, providers, payers, government agencies, academics, professional organizations and more—showed up in force, ready to bring something to the table and be a part of the solution. Takeaways from those discussions, billed as the Million Hearts CR Think Tank: Accelerating New Care Models, have recently been published in Circulation: Cardiovascular Quality and Outcomes.

The article’s corresponding author, Alexis Beatty, MD, MAS, who works out of the Department of Epidemiology and Biostatistics, Medicine at the University of California San Francisco, says think tank participants understood the assignment. In a nutshell, she explained, that was “to rethink how we’re delivering cardiac rehabilitation so that we can get it to more people and we can deliver it more equitably.” While this challenge demanded attention even before the COVID-19 pandemic, Beatty believes the issue gained more traction during the public health emergency, which affected in-person CR participation. After putting their heads together for three days, attendees reached consensus on several key recommendations.

Point Taken

Beatty touches on a handful of the primary impressions gleaned from the think tank.

• The change is not in what is delivered, but rather how it is delivered. “We’re still doing the same things but we’re just doing it in a different way,” Beatty elaborates.

• New ways of delivering CR are already here! Despite innovation, stakeholders believe that no matter how it is delivered, the essence of CR should be preserved. “It should still adhere to the core components of CR and should still be a multi-component, multi-disciplinary program,” Beatty says on behalf of the collective.

• The nomenclature needs to change.  “We’re trying to move away from the terminology ‘center-based’ and ‘home-based’ and just starting talking about ‘cardiac rehabilitation,’” Beatty reports. Going forward, there may be universal use of terms such as “synchronous” to describe either in-person or virtual sessions with a CR professional; and “asynchronous” to refer to exercise or activity done outside the presence of a CR professional but reported to him or her later through an app, phone call, or other communication.

• The health equity component is HUGE. Not only is this section of the proceedings document highly impactful, Beatty says, it offers some of the most specific guidance in terms of next steps. “It’s a little bit about calling out the disparities that exist but also about discussing specific strategies that can be used to improve equity,” she reflects. “Some of them relate to things we already do, like automated referrals and liaisons, some relate to eliminating co-pays for Medicare Advantage patients and some relate to ensuring coverage for Medicaid patients, among other strategies.”

While Beatty and her co-authors lay out many other recommendations and details from the think tank proceedings, she emphasizes that the paper is not a strategic plan. More aptly, it might be described as the outline of a strategic plan, or the beginning of the process—one that she’s eager to see through. “This is a really dedicated and passionate group of people from all the different groups, but especially from AACVPR and CDC,” Beatty says. “It’s just a really positive experience to get to work on projects like this.”