Despite strong evidence that such
exercise programs improve quality of life and reduce the likelihood of future
hospitalizations, a new UCLA-led study has found that only 1 in 10 heart
failure patients is referred to a cardiac rehabilitation program after being
hospitalized, The study was published online on August 17 in the Journal of the
American College of Cardiology and will appear in the August 25 print edition.
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| Man on Treadmill with Health Care Cardiac Rehabilitation Exercise Training |
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For the study, the researchers
reviewed data from a national database of more than 100,000 individuals with
heart failure who were discharged from hospitals between 2005 and 2014 and were
eligible for cardiac rehabilitation programs. “Although we expected some
under-referral to cardiac rehabilitation in the heart failure population, the
results of this study are startling,” explained senior author Gregg Fonarow,
MD, the Eliot Corday Chair in Cardiovascular Medicine and Science at the David
Geffen School of Medicine at UCLA. He added, “Given the individual and the
public health benefits of such programs and the escalating healthcare
expenditures related to heart failure hospitalizations, our findings point to
the need for better strategies to increase physicians’ and patients’ awareness
about the importance of cardiac rehabilitation.” Center.
Each year, 870,000 Americans are newly
diagnosed with heart failure, a condition in which the heart is unable to pump
enough blood and oxygen to support other organs in the body; overall,
congestive heart failure affects an estimated 6 million individuals and
accounts for more than 1 million hospitalizations annually and more than $30
billion in direct costs.
With the heart not able to pump
effectively, heart failure can lead to symptoms such as fatigue and shortness
of breath due to the accumulation of fluid and congestion in the lungs. A
number of studies have reported that patients who undergo a dedicated 36-week
cardiac rehabilitation program focused on aerobic exercise training are more
capable of controlling symptoms related to shortness of breath and are better
able to perform daily activities such as walking to the grocery store and
climbing stairs.
After a notable 2007 study (Heart
Failure and A Controlled Trial Investigating Outcomes of Exercise Training, or
HF–ACTION) found that individuals who underwent exercise training following
hospitalization for heart failure had an improved ability to perform normal
daily living tasks, were less likely to be re-hospitalized and had a lower
mortality rate, the American College of Cardiology and American Heart
Association issued guidelines recommending cardiac rehabilitation for medically
stable heart failure patients. In 2013, the federal Centers for Medicare and
Medicaid Services approved cardiac rehabilitation for eligible patients with
heart failure; thus, making it available to a broader group of Medicare
patients. The new UCLA study is the first since those guidelines were issued to
evaluate how often physicians refer their patients to such programs upon
discharge from the hospital, and the first to examine factors associated with
the referrals.
The investigators reviewed data on
105,619 hospitalized heart failure patients from the national Get With The
Guidelines–Heart Failure registry, which is a component of an American Heart
Association program. They discovered that during the study period, only 10.4%
of eligible patients were referred to a cardiac rehabilitation program when
they were discharged from the hospital. The referral rates did increase during
the study period; however, they remained low. The researchers found that
patients referred for cardiac rehabilitation tended to be younger than those
who were not, and men were referred more often than women. Patients who
received referrals were also more likely to receive guideline-recommended heart
failure medications when they were discharged.
“Physicians who are more likely to
incorporate state-of-the-art therapies in the management of heart failure
patients appear also to be more likely to refer their patients to cardiac
rehabilitation programs,” noted Dr. Fonarow. He added, “This suggests that
raising awareness about the benefits of these programs may be an effective
strategy for increasing referrals.” The authors noted that, of equal
importance, are efforts to increase insurance coverage and reduce copayments
for such programs, as well as expanding the responsibilities of home health
nurses, physical therapists, and other healthcare providers to widen the scope
of home- and community-based cardiac rehabilitation.
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| Cardiac Rehab for Healthy Heart |
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