The COVID-19 pandemic in 2020 was associated with a 12% lower prevalence of cardiac rehabilitation enrollment compared with 2017 (adjusted prevalence ratio 0.88; 95% CI, 0.85-0.90).
Cross-Sectional (n=143,870)
Did the COVID-19 pandemic reduce cardiac rehabilitation enrollment and completion among commercially insured adults?
Among commercially insured adults under 65, cardiac rehabilitation participation is low (24.2%) and worsened during the 2020 COVID-19 pandemic, though most metrics rebounded to prepandemic levels by 2022.
Effect estimate: adjusted prevalence ratio 0.88 (95% CI 0.85-0.90)
BACKGROUND: Cardiac rehabilitation (CR) reduces morbidity and mortality among individuals with heart disease. Although the COVID-19 pandemic disrupted health services, its impact on CR participation remains poorly understood-especially among commercially insured populations, for whom CR utilization trends are poorly documented. METHODS: This cross-sectional time series study of enrollees aged 18 to 64 years with ≥1 CR-qualifying event (acute myocardial infarction, coronary artery bypass graft, heart valve repair/replacement, percutaneous coronary intervention, or heart/heart-lung transplant) during 2017 to 2022, with follow-up through 2023, used MarketScan commercial claims data. Adjusted analyses used Poisson log-linear models with robust standard errors to examine trends in enrollment and completion (≥36 sessions), and generalized linear models with negative binomial distribution and log-link function to examine trends in days to enrollment and number of sessions. RESULTS: The sample included 143 870 unique individuals aged 18 to 64 years with a CR-qualifying event. Of the sample, the mean age was 53.9 (SD, 8.1), and 70% were men. On average, from 2017 to 2023, enrollment was 24.2%, days to enrollment were 46.3 (SD, 51.4 days), the number of sessions was 13.9 (SD, 12.8), and completion was 9.6%. Compared with year 2017, 2020 was associated with a 12% lower prevalence of enrollment (adjusted prevalence ratio, 0.88 95% CI, 0.85-0.90), 6-day longer time to enrollment on average (adjusted difference, 6.04 95% CI, 4.36-7.72), 1.2 fewer sessions on average (adjusted difference, -1.24 95% CI, -1.72 to -0.75), and 13% lower prevalence of completion (prevalence ratio, 0.87 95% CI, 0.78-0.97). All metrics rebounded to prepandemic levels, except days to enrollment (4 days longer in 2022 versus 2017; adjusted difference, 3.78 95% CI, 2.22-5.34). CONCLUSIONS: Among commercially insured adults <65 years, only one-quarter of eligible individuals participated in CR. CR metrics worsened during the COVID-19 pandemic in 2020, but most rebounded to prepandemic levels. These findings highlight an opportunity for health systems and public health initiatives to support broader CR uptake.
Pollack et al. (Mon,) conducted a cross-sectional in CR-qualifying event (acute myocardial infarction, coronary artery bypass graft, heart valve repair/replacement, percutaneous coronary intervention, or heart/heart-lung transplant) (n=143,870). Year 2020 (COVID-19 pandemic) vs. Year 2017 was evaluated on Prevalence of enrollment in cardiac rehabilitation (adjusted prevalence ratio 0.88, 95% CI 0.85-0.90). The COVID-19 pandemic in 2020 was associated with a 12% lower prevalence of cardiac rehabilitation enrollment compared with 2017 (adjusted prevalence ratio 0.88; 95% CI, 0.85-0.90).