Key result
Cardiac rehab enrollment shows massive hospital variation, with ~1% achieving national goals.
Why the study?
Despite national goals to enroll 70% of cardiac rehabilitation-eligible patients, enrollment remains low, and the influence of the treating hospital nationally was unknown.
Observational (n=264,970)
Yes
Hospital-level cardiac rehabilitation enrollment rates remain low and highly variable, with fewer than 1% of U.S. hospitals achieving the national goal of 70% enrollment.
CR enrollment remains far below national goals in nearly all U.S. hospitals; leaves open identification of scalable hospital-level strategies.
Background: Despite national goals to enroll 70% of cardiac rehabilitation (CR)-eligible patients, enrollment remains low. Objectives: The purpose of this study was to evaluate how the treating hospital influences CR enrollment nationally. Methods: We included Fee-for-Service Medicare beneficiaries aged ≥66 years who were hospitalized for acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or heart valve repair/replacement. We examined: 1) a risk-standardized model to assess comparative hospital rates; 2) a linear regression model to identify hospital factors associated with rates of risk-standardized CR; and 3) a hierarchical generalized linear model to calculate the hospital median OR. Results: At 3,420 hospitals, we identified 264,970 eligible patients. A minority of hospitals (n = 1,446; 38%) performed cardiac surgery, but these hospitals cared for the majority (n = 242,875; 92%) of all eligible patients. Subsequent analyses were limited to these hospitals. The median risk-standardized CR enrollment rate was low (22%) and varied 10-fold across hospitals (10th, 90th percentile: 3%, 42%). Factors associated with higher hospital performance were Midwest location, higher number of hospital beds, directly affiliated CR program, and <1 mile distance between the hospital and closest CR facility. The national hospital median OR was 2.1. Conclusions: The treating hospital plays a key role in facilitating CR enrollment after discharge. Fewer than 1% of U.S. hospitals achieved a risk-standardized CR enrollment rate of >70%. Hospitals with cardiac surgery capability care for more than 90% of all CR-eligible patients and may be a logical place to focus improvement efforts.
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Pack et al. (2024) conducted an observational in Acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or heart valve repair/replacement (n=264,970). Hospital-level factors was evaluated on Risk-standardized cardiac rehabilitation enrollment rate (Median OR 2.1). Hospital-level risk-standardized cardiac rehabilitation enrollment rates varied 10-fold (median 22%), with fewer than 1% of U.S. hospitals achieving the national goal of >70% enrollment.
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