The density of cardiac rehabilitation programs accounted for 23.5% of the geographic variation in cardiac rehabilitation initiation, with 13% of the older US population living in CR deserts.
Observational (n=1,269,147)
Does geographic access to cardiac rehabilitation centers affect CR initiation rates among eligible Medicare beneficiaries?
A substantial proportion of the geographic variation in cardiac rehabilitation initiation is driven by access to CR programs, highlighting the need to address 'CR deserts' to improve utilization.
Effect estimate: 23.5% of geographic variation explained
p-value: p=<0.0001
Structured Abstract Background: There is marked geographic variation in cardiac rehabilitation (CR) initiation, ranging from 10-40% of eligible patients at the state level. The potential causes of this variation, such as patient access to CR centers, are not well studied. Objectives: The authors sought to determine how access to CR centers affects CR initiation in Medicare beneficiaries. Methods: The authors used Medicare files to identify CR-eligible Medicare beneficiaries and calculate CR initiation rates at the hospital referral region (HRR) level. We used linear regression to evaluate the percent variation in CR initiation accounted for by CR access across HRRs. We then employed geospatial hotspot analysis to identify CR deserts, or counties in which patient load per CR center is disproportionately high. Results: A total of 1,269,147 Medicare beneficiaries were eligible for CR from 2014 to 2017, of whom 314,997 (25%) initiated CR. The West North Central Census Division had the highest adjusted CR initiation rate (37.0%) and the highest density of CR programs (5.89 per 1,000 CR-eligible Medicare beneficiaries). Density of CR programs accounted for 23.5% of geographic variation in CR initiation at the HRR level. A total of 39 largely urban counties comprising 13% of the United States population age ≥65 had disproportionately low CR access and were identified as CR deserts. Conclusions: A substantial proportion of geographic variation in CR initiation was related to access to CR programs, with a significant amount of the U.S. population living in CR deserts. These data invite further study on interventions to increase CR access.
Duncan et al. (Wed,) conducted a observational in Cardiovascular disease eligible for cardiac rehabilitation (n=1,269,147). Density of cardiac rehabilitation programs vs. Lower density of cardiac rehabilitation programs was evaluated on Cardiac rehabilitation initiation (≥1 outpatient claim for CR in the year following discharge) (23.5% of geographic variation explained, p=<0.0001). The density of cardiac rehabilitation programs accounted for 23.5% of the geographic variation in cardiac rehabilitation initiation, with 13% of the older US population living in CR deserts.