Despite strong evidence that such exercise programs improve quality of life and reduce the likelihood of future hospitalizations, a new UCLA-led study has found that only 1 in 10 heart failure patients is referred to a cardiac rehabilitation program after being hospitalized, The study was published online on August 17 in the Journal of the American College of Cardiology and will appear in the August 25 print edition.
For the study, the researchers reviewed data from a national database of more than 100,000 individuals with heart failure who were discharged from hospitals between 2005 and 2014 and were eligible for cardiac rehabilitation programs. “Although we expected some under-referral to cardiac rehabilitation in the heart failure population, the results of this study are startling,” explained senior author Gregg Fonarow, MD, the Eliot Corday Chair in Cardiovascular Medicine and Science at the David Geffen School of Medicine at UCLA. He added, “Given the individual and the public health benefits of such programs and the escalating healthcare expenditures related to heart failure hospitalizations, our findings point to the need for better strategies to increase physicians’ and patients’ awareness about the importance of cardiac rehabilitation.” Center.
Each year, 870,000 Americans are newly diagnosed with heart failure, a condition in which the heart is unable to pump enough blood and oxygen to support other organs in the body; overall, congestive heart failure affects an estimated 6 million individuals and accounts for more than 1 million hospitalizations annually and more than $30 billion in direct costs.
With the heart not able to pump effectively, heart failure can lead to symptoms such as fatigue and shortness of breath due to the accumulation of fluid and congestion in the lungs. A number of studies have reported that patients who undergo a dedicated 36-week cardiac rehabilitation program focused on aerobic exercise training are more capable of controlling symptoms related to shortness of breath and are better able to perform daily activities such as walking to the grocery store and climbing stairs.
After a notable 2007 study (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise Training, or HF–ACTION) found that individuals who underwent exercise training following hospitalization for heart failure had an improved ability to perform normal daily living tasks, were less likely to be re-hospitalized and had a lower mortality rate, the American College of Cardiology and American Heart Association issued guidelines recommending cardiac rehabilitation for medically stable heart failure patients. In 2013, the federal Centers for Medicare and Medicaid Services approved cardiac rehabilitation for eligible patients with heart failure; thus, making it available to a broader group of Medicare patients. The new UCLA study is the first since those guidelines were issued to evaluate how often physicians refer their patients to such programs upon discharge from the hospital, and the first to examine factors associated with the referrals.
The investigators reviewed data on 105,619 hospitalized heart failure patients from the national Get With The Guidelines–Heart Failure registry, which is a component of an American Heart Association program. They discovered that during the study period, only 10.4% of eligible patients were referred to a cardiac rehabilitation program when they were discharged from the hospital. The referral rates did increase during the study period; however, they remained low. The researchers found that patients referred for cardiac rehabilitation tended to be younger than those who were not, and men were referred more often than women. Patients who received referrals were also more likely to receive guideline-recommended heart failure medications when they were discharged.
“Physicians who are more likely to incorporate state-of-the-art therapies in the management of heart failure patients appear also to be more likely to refer their patients to cardiac rehabilitation programs,” noted Dr. Fonarow. He added, “This suggests that raising awareness about the benefits of these programs may be an effective strategy for increasing referrals.” The authors noted that, of equal importance, are efforts to increase insurance coverage and reduce copayments for such programs, as well as expanding the responsibilities of home health nurses, physical therapists, and other healthcare providers to widen the scope of home- and community-based cardiac rehabilitation.