Geographic Variations in Cardiac Rehabilitation Use

Abstract

Article, see p 1899The article entitled “Geographic Variation in Cardiac Rehabilitation Participation in Medicare and Veterans Affairs Populations: Opportunity for Improvement”1 in this issue of Circulation presents a trove of data relevant to efforts aimed at expanding utilization of cardiac rehabilitation (CR) for appropriate patients. Yet these data are sobering. From 1997 to 2011, despite a seeming uptick in CR referral from 2007 to 2012,2 there has been no improvement whatsoever in enrolling appropriate Medicare patients to participate in CR (19% in 1997 versus 16% in 2007–2011), with the lower rate because of a lower rate of coronary bypass surgery in the more recent cohort.3 The situation for patients in the Veterans Affairs (VA) system is yet more concerning, with a 10% participation rate in 2007 to 2011 despite a slightly younger population and the seeming advantage of the VA to systematically deliver care compared with the more heterogeneous US healthcare system.1 Even when only veterans ≥65 years of age are examined, the participation rate was lower in the VA system than for patients on Medicare. These persistently low participation rates are striking in light of the robust literature on the multiple benefits of CR: a 13% reduction in total mortality, a 26% reduction in cardiovascular mortality, a 31% decrease in rehospitalizations, and improved quality of life.4,5In line with the landmark analysis of Suaya et al3 of CR participation rates in 1997 for patients on Medicare, regional variations in CR participation have persisted, with the highest participation rates for both Medicare and VA systems in North Central states (34% Centers for …