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Few Veterans with Heart Failure Participate in Cardiac Rehabilitation

By U.S. Medicine

By Annette M. Boyle

Linda Park, PhD, NP, of the San Francisco VAMC and assistant professor at the University of California, San Francisco

SAN FRANCISCO—Despite evidence that cardiac rehabilitation reduces morbidity and mortality, few patients with heart failure undertake it, including veterans who often have difficulty accessing center-based programs.

In the general population, insurance companies and Medicare did not cover cardiac rehabilitation until 2014, but the VA has offered cardiac rehabilitation to heart failure patients for years. A new study sheds light on veteran participation and identifies ways to increase the number who benefit from this effective outpatient program.

In a study published in the Journal of Cardiac Failure, researchers at the San Francisco VAMC looked at cardiac rehabilitation rates among veterans and Medicare beneficiaries who had been hospitalized for heart failure between Jan. 1, 2007, and Dec. 31, 2011. A random sample of 5% of Medicare claims obtained from multiple databases identified 243,208 unique Medicare beneficiaries and 66,710 veterans for the retrospective study.1

Of these heart failure patients, 2.3% of the veterans and 2.6% of the Medicare beneficiaries attended one or more rehabilitation sessions. Over the five-year period studied, rehab utilization rose steadily among Medicare beneficiaries, from 1.3% to 3.1%, while remaining relatively low, at about 2%, among veterans.

Male Medicare beneficiaries were more than twice as likely to participate in rehabilitation than female beneficiaries (3.7% vs. 1.8%), but little difference in participation rates between male and female veterans was determined. Married veterans and those with higher incomes were more likely to utilize rehabilitation services, according to the analysis.

The low rates of rehabilitation in both groups contribute to a poor prognosis. Heart failure has a 30% one-year mortality rate, but rehabilitation can tip the scales for some patients.

According to the VA, “studies have shown that people who complete a cardiac rehabilitation program can increase their life expectancy by up to five years and have 27% lower cardiac death rates, 25% fewer fatal heart attacks, 21% fewer nonfatal heart attacks and an improved quality of life.”


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