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Cardiac rehabilitation participation was woefully low among eligible Medicare patients with heart disease in 2016-2017, researchers said.

Just 24.4% of eligible beneficiaries ended up participating in cardiac rehabilitation, researchers led by Matthew Ritchey, DPT, MPH, of the CDC in Atlanta, showed in .

And of those participants, only 24.3% initiated their rehabilitation programs in a timely manner (within 21 days of event) and 26.9% actually completed the program by the end of the year after becoming eligible.

"The low participation and completion rates observed in this study translate to upwards of 7 million missed opportunities to potentially improve health outcomes had 70% of eligible beneficiaries participated in cardiac rehabilitation and completed 36 sessions," Ritchey's group said, referring to the national 's goal of 70% utilization by the year 2022.

In their study, 366,103 Medicare fee-for-service beneficiaries became eligible for these programs in 2016 due to a qualifying event: acute MI hospitalization, coronary artery bypass surgery, heart valve repair or replacement, percutaneous coronary intervention, or heart/heart-lung transplant.

Records showed that participants averaged 24.8 cardiac rehab sessions in total.

Medicare patients in the study were responsible for roughly 20% of cost-sharing for cardiac rehabilitation, potentially racking up an estimated $828 in copays for a full course of 36 sessions.

"This amount, in addition to ancillary costs associated with transportation, missed employment, or arranging for alternative caregiving for family members, could serve as financial barriers for CR use, especially among beneficiaries without supplemental insurance and with low socioeconomic status," Ritchey and colleagues suggested.

The study showed marked disparities in cardiac rehabilitation (CR) participation, the authors noted:

• Lower utilization with increasing age
• Lower utilization among women compared with men
• Lower participation among Hispanics and blacks compared with non-Hispanic whites
• Variation by geographic region (e.g., Southeast and Appalachia tended to have the lowest participation but the highest completion, while the Midwest had the highest participation and the lowest completion)
• Variation by qualifying event type (e.g., lowest after acute MI hospitalization without revascularization, and highest with coronary artery bypass surgery)

"While additional work is needed to better understand these findings, it has been suggested that much of the regional variation in CR use can be addressed by hospitals and community-based practices integrating systematic CR referrals and other pro-CR processes within standardized treatment protocols, improving the capacity within existing CR programs, and addressing shortages in available programs, especially in rural areas," according to Ritchey's team.

It was possible that not all confounders were accounted for in the statistical analyses. The researchers were also unable to exclude all beneficiaries for whom cardiac rehabilitation was not appropriate, therefore potentially underestimating participation rates.

"A wealth of guidance exists that identifies the evidence-based strategies that can be used to increase CR use," they noted. "Hospitals, CR programs, and other stakeholders can consider systematically integrating these strategies into their processes and tracking the effects of their implementation using established quality and performance measures."

For example, they cited the , a list of process improvements that hospitals can implement to improve cardiac rehabilitation referral, enrollment, participation, and adherence.

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