Use of Outpatient Cardiac Rehabilitation Among Heart Attack Survivors — 20 States and the District of Columbia, 2013 and Four States, 2015

Abstract

Heart disease is the leading cause of death in the United States (1). Each year, approximately 790,000 adults have a myocardial infarction (heart attack), including 210,000 that are recurrent heart attacks (2). Cardiac rehabilitation (rehab) includes exercise counseling and training, education for heart-healthy living, and counseling to reduce stress. Cardiac rehab provides patients with education regarding the causes of heart attacks and tools to initiate positive behavior change, and extends patients' medical management after a heart attack to prevent future negative sequelae (3). A systematic review has shown that after a heart attack, patients using cardiac rehab were 53% (95% confidence interval [CI] = 41%-62%) less likely to die from any cause and 57% (95% CI = 21%-77%) less likely to experience cardiac-related mortality than were those who did not use cardiac rehab (3). However, even with long-standing national recommendations encouraging use of cardiac rehab (4), the intervention has been underutilized. An analysis of 2005 Behavioral Risk Factor Surveillance System (BRFSS) data found that only 34.7% of adults who reported a history of a heart attack also reported subsequent use of cardiac rehab (5). To update these estimates, CDC used the most recent BRFSS data from 2013 and 2015 to assess the use of cardiac rehab among adults following a heart attack. Overall use of cardiac rehab was 33.7% in 20 states and the District of Columbia (DC) in 2013 and 35.5% in four states in 2015. Cardiac rehab use was underutilized overall and differences were evident by sex, age, race/ethnicity, level of education , cardiovascular risk status, and by state. Increasing use of cardiac rehab after a heart attack should be encouraged by health systems and supported by the public health community. The BRFSS is a telephone survey, conducted annually by all U.S states, with guidance and support from CDC (https:// www.cdc.gov/brfss). The survey includes a core component and optional modules. Participants with history of a heart attack are identified by an affirmative response to the question, "Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?" In 2013, 20 states* and DC, and in 2015, four states † included the cardiovascular health module, which contained questions about using cardiac rehab after a heart attack. The median response rates for the BRFSS were 46.4% and 47.2% for 2013 and 2015, respectively. Participants identified as heart attack survivors were asked: "After you left the hospital following your heart attack, did you go to any kind of outpatient rehabilitation?" Demographic characteristics included age, sex, race/ethnicity (non-Hispanic white, non-Hispanic black, non-Hispanic other, or Hispanic), highest level of education achieved (less than high school, high school graduate, some college, or college graduate) and having *