Key result
Cardiac rehabilitation linked to ~48 fewer annual hospitalizations per 1000 beneficiaries and lower Medicare costs.
Why the study?
Although cardiac rehabilitation improves cardiovascular health, it was unclear whether participation and the amount of participation were associated with fewer subsequent hospitalizations, emergency visits, and lower expenditures.
Does cardiac rehabilitation participation reduce subsequent inpatient hospitalizations and healthcare expenditures in eligible Medicare fee-for-service beneficiaries?
Observational (n=57,668)
Does cardiac rehabilitation participation reduce subsequent inpatient hospitalizations and healthcare expenditures in eligible Medicare fee-for-service beneficiaries?
Effect estimate: Difference -47.6 (95% CI -58.8 to -36.3)
Cardiac rehabilitation participation among eligible Medicare beneficiaries is associated with significantly fewer subsequent inpatient hospitalizations and lower Medicare expenditures, with a dose-response relationship for greater participation.
May support broader cardiac rehabilitation referral in Medicare beneficiaries; leaves open causality for reduced hospitalizations and expenditures.
BACKGROUND: Cardiac rehabilitation (CR) can improve cardiovascular health. We identified whether CR participation was associated with fewer subsequent inpatient hospitalizations and emergency department visits and less Medicare and out-of-pocket expenditures, and whether outcomes varied by amount of participation. METHODS: This retrospective study used Medicare fee-for-service claims data, including beneficiaries with a CR-qualifying event in 2016. Participants attended ≥2 sessions of CR within 365 days of the event. Propensity score matching was used to identify CR-eligible nonparticipants. Difference-in-differences analyses were used to compare differences in outcomes before (2014-2015) and after (2018-2019; 2-year CR period=2016-2017) the CR period between participants and nonparticipants. RESULTS: We identified 57 668 CR-eligible beneficiaries after matching, with equal numbers of participants and nonparticipants. Nearly 65% of beneficiaries had a percutaneous coronary intervention, 33.5% had an acute myocardial infarction, 17.5% had a coronary artery bypass graft, and 16.8% had a heart valve repair/replacement. Compared with nonparticipants, participants had 47.6 fewer subsequent annual inpatient hospitalizations per 1000 beneficiaries (95% CI, -58.8 to -36.3) and $1005 lower subsequent annual Medicare expenditures per beneficiary (95% CI, -$1352 to -$659). Compared with no participation, medium participation (12-23 sessions), high participation (24-35 sessions), and CR completion (≥36 sessions) were associated with fewer inpatient hospitalizations and lower Medicare expenditures per year. CONCLUSIONS: CR was associated with fewer subsequent annual inpatient hospitalizations and lower subsequent annual Medicare expenditures. A higher amount of participation was associated with a further reduction in hospitalizations and expenditures. These findings can inform programs and policies that encourage CR participation.
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Pollack et al. (2025) conducted an observational in Cardiac rehabilitation-qualifying event (n=57,668). Cardiac rehabilitation vs. No participation was evaluated on Subsequent annual inpatient hospitalizations per 1000 beneficiaries (Difference -47.6, 95% CI -58.8 to -36.3). Cardiac rehabilitation participation was associated with 47.6 fewer annual inpatient hospitalizations per 1000 beneficiaries (95% CI, -58.8 to -36.3) and $1005 lower Medicare expenditures.
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