Key result
Copayments are linked to ~5 fewer cardiac rehabilitation sessions attended vs no copay.
Why the study?
Improving cardiac rehabilitation participation is a national priority, but the prevalence and cost of copays and their relationship with attendance and dropout required evaluation.
Does the presence and amount of out-of-pocket copayments reduce session attendance and increase dropout in adults enrolled in cardiac rehabilitation?
Cohort (n=59,838)
Yes
Does the presence and amount of out-of-pocket copayments reduce session attendance and increase dropout in adults enrolled in cardiac rehabilitation?
In this nationwide US registry analysis of 59,838 patients, out-of-pocket copayments were present in 27.3% of cardiac rehabilitation participants, were associated with attending ~5 fewer sessions in a dose-dependent manner, and accounted for nearly a quarter of early dropouts.
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Supports policy efforts to eliminate copayments for cardiac rehabilitation; extends observational evidence on adherence barriers but needs prospective trials.
Background Improving cardiac rehabilitation (CR) participation is a national priority. This study examines the prevalence and cost of copays and their relationship with CR attendance and dropout. Methods We analyzed the AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation) registry using the AACVPR Data Analytic Center, including patients from 2012 to 2021 with recorded copayment (including 0) while excluding those without this data. The primary outcome was the association between total CR sessions attended and both copay presence and amount, assessed using multivariable models, adjusting for key literature‐based adherence predictors and baseline patient characteristics. Results Among 59 838 patients with copay data, 16 339 (27.3%) had a copay. The median (interquartile range) copay was $24.00 (20, 34). Medicare, Medicaid, private, and Other insurances charged a median (interquartile range) copay of $20.00 (20–25), $3.70 (3, 12), $30.00 (20–40), and $25.00 (20 to 36), respectively. Copays were more common in New York and the Northeast and less common in California and the Midwest. The highest copay amounts were observed in South Dakota, Oklahoma, and Connecticut (>$34.00). In multivariable model, the presence of copay was associated with attendance at 4.9 (95% CI: 4.3 to 5.6, P <0.001) fewer sessions of CR. Every $10 increase in copay was associated with 0.5 (0.4 to 0.6, P <0.001) fewer CR sessions. Copays were cited as the reason for early dropout in 23% of cases. Conclusions Copays for CR were common, costly, and associated with fewer CR sessions. Policymakers should reconsider these policies to promote CR participation.
Thapa et al. (2026) conducted a cohort in Cardiovascular conditions eligible for cardiac rehabilitation (including MI, PCI, CABG, valve surgery, heart failure, stable angina, TAVR, VAD, or heart transplant) (n=59,838). Out-of-pocket copayment for cardiac rehabilitation sessions vs. Zero copayment (no copay) was evaluated on Total number of cardiac rehabilitation sessions attended (MD -4.94 sessions, 95% CI -5.61 to -4.27, p=<0.0001). The presence of a copayment was associated with attendance at 4.9 fewer cardiac rehabilitation sessions compared with having no copayment.
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