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Senior Citizen Health & Medicine
Few Senior Citizens Take Advantage of
Medicare-Provided Cardiac Rehab
Older, female, non-white: biggest offenders; varies,
too, by state
 Sept. 26, 2007 – Even though Medicare pays for it,
senior citizens are terrible about following through with cardiac
rehabilitation after a heart attack or coronary bypass surgery. Fewer
than 20 percent – less than one out of five – take advantage of this
free benefit despite strong evidence that it reduces disability and
prolongs life.
Overall, the new Brandeis study found that, despite
Medicare coverage of cardiac rehabilitation sessions, among Medicare
beneficiaries aged 65 and above, women participated less than men, older
people less than younger, and non-whites significantly less than whites.
Additionally, the researchers noted striking geographic differences in
the use of cardiac rehabilitation after cardiac hospitalizations,
ranging from 53.5 percent of patients in Nebraska to 6.6 percent in
Idaho.
“We need to find ways to increase the use of
cardiac rehabilitation, because it is used very little by patients who
could benefit a lot,” said Jose A. Suaya, M.D., Ph.D., lead author of
the study and a lecturer and scientist at the Schneider Institutes for
Health Policy, Heller School, at Brandeis University in Waltham, Mass.
“Almost all patients with stable angina or a
recent heart attack, bypass surgery, or a coronary stent could benefit
from cardiac rehabilitation,” Suaya said. “Importantly, this benefit
applies regardless of age, gender or race.”
“Patients and their families should ask for
referral to cardiac rehabilitation before they are discharged from the
hospital,” said co-author Donald S. Shepard, Ph.D., professor at the
Heller School. “This is particularly important for patients with other
medical conditions, who are less likely to receive a referral.”
In the largest and most comprehensive study of its
kind, researchers evaluated Medicare claims data on 267,427 men and
women aged 65 and above who survived at least 30 days after hospital
discharge following a heart attack or coronary bypass surgery in 1997.
In the year following hospital discharge, fewer
than one in five (18.7 percent) patients in the study had at least one
session of cardiac rehabilitation. Bypass patients (31.0 percent) were
far more likely to receive rehabilitation than patients who had had a
heart attack (13.9 percent).
“Coronary bypass surgery is a big event for most
patients and cardiac rehab has been adopted as a very important
component of recovery,” said William B. Stason, M.D., M.Sci., study
co-author and senior scientist at the Heller School. “In contrast, the
condition of patients after heart attack varies widely and there is less
agreement among physicians about the value of cardiac rehab compared
with medications and lifestyle changes.”
Cardiac rehabilitation sessions include supervised
and monitored exercise to improve cardiovascular fitness, as well as
assistance in making lifestyle changes such as smoking cessation,
improving diet and learning to reduce stress.
At the time of the study, Medicare (the primary
health insurer for people age 65 and older) provided coverage for up to
36 sessions (three per week for three months) of cardiac rehabilitation
after heart attack, bypass surgery, or stable angina. Rehabilitation
patients in this study had an average of 24 sessions. In 2006, Medicare
expanded to include patients undergoing heart and lung transplants,
heart valve surgery and procedures such as stenting and angioplasty.
“Every patient who has had a myocardial infarction
or is hospitalized for coronary disease should at least be considered as
a candidate for rehab at the time of discharge,” Stason said.
In the study, use of cardiac rehabilitation
differed by age and gender. Overall, the use of cardiac rehab in men
(22.1 percent) was significantly higher than in women (14.3 percent).
Compared with men age 65 – 74, the likelihood of receiving cardiac rehab
was:
● 2 percent lower in women age 65–74;
● 13 percent lower in men and 31 percent lower in women age 75–84;
● 71 percent lower in men and 83 percent lower in women age 85 and
older.
“I think differences in the use of cardiac
rehabilitation for different age groups reflects physicians’
preconceptions about less value in older people rather than a careful
look at the clinical evidence. There is an increasing body of research
showing that increased exercise is just as valuable, if not more so, in
older people, and is important in preserving their ability to function,”
Stason said.
Overall, use of cardiac rehab was twice as great in
white as in non-white patients. Lower-income elders who were eligible
for Medicaid as well as Medicare, were far less likely (5.2 percent) to
receive rehabilitation than those not on Medicaid (20.3 percent).
Furthermore, patients with co-existing medical conditions, such as
diabetes, a previous stroke, congestive heart failure or cancer, were
significantly less likely to participate in cardiac rehab, according to
the report.
Shepard said that further study is needed of
potential approaches to increase use of this effective service. These
include analyzing reimbursement rates for cardiac rehabilitation in
relation to their costs, studying referral patterns in high use states,
and seeing whether the utilization rate of rehabilitation services among
Medicare patients should be made a quality indicator for cardiac care.
Editor’s Notes:
The Brandeis study is published in Circulation:
Journal of the American Heart Association.
Other co-authors are Sharon-Lise T. Normand, Ph.D.
(Harvard Medical School); Philip Ades, M.D. (University of Vermont) and
Jeffrey Prottas, Ph.D. (Brandeis University). The Centers for Medicare &
Medicaid Services funded the study.
What is Cardiac Rehabilitation (American Heart
Association)
What is cardiac rehabilitation?
Cardiac rehabilitation (cardiac rehab) is a
professionally supervised program to help people recover from heart
attacks, heart surgery and percutaneous coronary intervention (PCI)
procedures such as stenting and angioplasty. Cardiac rehab programs
usually provide education and counseling services to help heart patients
increase physical fitness, reduce cardiac symptoms, improve health and
reduce the risk of future heart problems, including heart attack.
Who needs a cardiac rehab program?
Many people of all ages who have heart conditions
can benefit from a cardiac rehab program. You may benefit if you have or
have had a:
● Heart attack
● Heart condition, such as coronary artery
disease (CAD), angina or heart failure
● Heart procedure or surgery, including coronary
artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI),
including coronary angioplasty (balloon angioplasty) and stenting, valve
replacement, or a pacemaker or implantable cardioverter defibrillator (ICD)
>>
Read more at American Heart Association
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