Transforming Care Through Cardiac Rehabilitation

Illustration: Lee Sauer

For more than a decade, evidence-based cardiac rehabilitation (CR) has been a Class I indication in clinical guidelines for patients with chronic stable angina, STEMI and NSTEMI, patients undergoing PCI and CABG, and heart failure. The benefits of CR speak for themselves. Evidence clearly shows that CR reduces all-cause mortality by 50% compared to patients with no CR, and it improves risk factors, functional status, quality of life, medication adherence, and keeps patients out of the hospital. A recent publication based on research at Mayo Clinic determined that there is a positive linear health benefit to the number of CR sessions – more sessions equivalated to a greater risk reduction with no upper threshold limit. In fact, their research showed that patients significantly benefit even after one additional session.ⁱ

Strong evidence lends to the incredible, life-changing value of CR for patients and highlights the need across the community. Yet despite the benefits, participation rates remain low – only 19% to 34% of eligible patients participate in CR, and women and minorities fall at the lower end of the participation range.ⁱⁱ The rationale for low enrollment is is similar to what other evidence-based therapy programs experience; socioeconomic factors such as insurance coverage and program reimbursement compounded by psychosocial elements create barriers for patient commitment to follow-through. Furthermore, there is a general lack of awareness about the benefits of CR from both the patient and the provider-side of care. Increasing education, sharing knowledge, and building and optimizing sustainable CR programs are crucial to meet patient care needs. Read more about CR obstacles and opportunities in this Cardiology magazine article, Cardiac Rehabilitation Obstacles and Opportunities.

MedAxiom and the American College of Cardiology share a mission: To transform cardiovascular care and to improve heart health. The direct and indirect impacts of improving participation of CR across the nation are multifold. CR can transform patients’ lives and the lives of their loved ones, in addition to empowering providers and care teams. In fact, one could justify that it’s a moral imperative to prescribe and support the adoption of CR just as providers would not think twice about prescribing aspirin to their patients after acute myocardial infarction.

In 2021, MedAxiom conducted a survey focusing on CR, intensive cardiac rehab (ICR) and virtual cardiac rehabilitation to better understand practices that lead to program effectiveness as well as potential barriers to enrollment and graduation. Over 70 programs completed the survey offering valuable insights related to CR program offerings, completion rates, staffing, leadership, barriers and more. Access the report here and watch the webinar recording here.

Getting your organization started with CR or taking your existing program to the next level is simpler than you may think. CR programs can vary in size and infrastructure, but the capital costs necessary to begin are comparatively lower than other types of evidence-based programs. Cardiovascular Institute of the South and Arkansas Heart Hospital have leading CR programs and shared their insights on best practices with the MedAxiom community last fall. Learn how to start up and take your program to the next level in this CV Transforum Fall’21 Session.

Building financially sustainable CR programs with improved patient engagement and outcomes can be further supported through ICR, which has significantly higher patient completion rates, improved outcomes, better reimbursement and stronger programmatic success. To clarify, ICR is not a more “intensive” version of traditional CR, but rather a distinct and separate Medicare-approved program that has a greater focus on nutrition counseling, lifestyle habit building, exercise, and personalized coaching. Learn about how MedAxiom industry partner, Pritikin ICR, can improve patient outcomes and enhance patient satisfaction through their comprehensive program here.

CR is the least prescribed cardiovascular Class I recommendation, yet it can provide extraordinary benefits. Patients deserve these services, so we must spread awareness of its value, increase referrals of eligible patients, support the adoption and growth of CR programs at organizations, and remove barriers for both patients and organizations. By working with dedicated communities like the ACC, AACVPR, Million Hearts and others to unite the community around this initiative, we can transform cardiovascular care, together.

ⁱ Medina-Inojosa JR, Grace SL, Supervia M, Stokin G, Bonikowske AR, Thomas R, Lopez-Jimenez F. Dose of Cardiac Rehabilitation to Reduce Mortality and Morbidity: A Population-Based Study. J Am Heart Assoc. 2021 Oct 19;10(20):e021356. doi: 10.1161/JAHA.120.021356. Epub 2021 Oct 6. PMID: 34612055; PMCID: PMC8751887.

ⁱⁱ Ritchey MD, Maresh S, McNeely J, Shaffer T, Jackson SL, Keteyian SJ, Brawner CA, Whooley MA, Chang T, Stolp H, Schieb L, Wright J. Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative. Circ Cardiovasc Qual Outcomes. 2020 Jan;13(1):e005902. doi: 10.1161/CIRCOUTCOMES.119.005902. Epub 2020 Jan 14. PMID: 31931615; PMCID: PMC8091573.