Newly expanded Medicare and Medicaid coverage for cardiac rehabilitation has tripled the number of heart failure patients with access to these lifesaving programs, a new study has found.
But coverage could stand to be even further expanded, the researchers concluded.
“There are a lot of new patients eligible, but we left out this whole huge bucket of patients,” said lead researcher Dr. Jacob Kelly, a heart physician at the Duke University School of Medicine, in Durham, N.C. “Now the question is, what should we do with this group?”
Cardiac rehabilitation is a medically supervised program that helps people with heart problems improve the quality of their lives, according to the American Heart Association (AHA).
Heart patients in cardiac rehabilitation participate in exercise training, take classes on heart healthy living, and receive counseling to help them better deal with emotional problems such as stress or depression, the AHA says.
In February 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) decided to expand coverage of cardiac rehabilitation programs, Kelly said.
Under the new CMS guidelines, any person with stable but chronic heart failure that meets certain standards can now participate in cardiac rehabilitation, Kelly said. The patient has to be receiving optimal medical care and have an ejection fraction of 35 percent or less, the researchers said. Ejection fraction is a measure of the heart’s ability to pump blood.
Prior to this change, cardiac rehabilitation was only available to people with specific heart conditions. For example, people who already had had a heart attack or had received a heart-valve replacement were eligible.
To see how this change expanded coverage, researchers reviewed data from the AHA’s Get With The Guidelines – Heart Failure registry. The registry includes nearly 52,000 heart failure patients.
About 15 percent of patients in the registry previously had been eligible, the study showed. But, under the new guidelines 27 percent had recently gained access to cardiac rehabilitation, the investigators found.
That still leaves nearly three of every five heart failure patients in the registry without Medicare or Medicaid coverage for cardiac rehabilitation, however.
Examining differences between the groups of patients, researchers found that people who already were eligible for cardiac rehabilitation had a lower death rate than either those who just gained access to the programs or those who remained ineligible.
The group of previously eligible patients had a one-year death rate of 32.5 percent, while both newly eligible and ineligible patients had a death rate of about 36 percent, Kelly said.
Given that death and hospitalization rates are similar between newly eligible people and people still without access, the researchers question whether Medicare and Medicaid shouldn’t further extend access to more people suffering from heart failure.
“We’ve identified a new population of patients who could benefit from this rehabilitation,” Kelly said.
Dr. Patrick O’Gara, executive medical director of the Shapiro Cardiovascular Center at Brigham and Women’s Hospital in Boston, said there’s no question that more heart patients could benefit from cardiac rehabilitation.
“Improving access to programs of cardiac rehabilitation should be a priority for policymakers in the United States,” he said.
Ultimately, O’Gara would like to see access expanded to include all people who are at high risk for a stroke or heart attack.
“We could step in and provide them tools to avoid a future event,” O’Gara said.
Kelly presented his findings Nov. 10 at the American Heart Association meeting in Orlando, Fla. Findings presented at meetings are generally viewed as preliminary until published in a peer-reviewed journal.
For more on cardiac rehabilitation, visit the American Heart Association.