Only a third of heart attack survivors go to outpatient cardiac rehabilitation as part of their recovery despite evidence that suggests it could lower the risk of a repeat attack, according to a new government report. Researchers believe patients face financial barriers to rehab.
A study published this week by the Centers for Disease Control and Prevention examined cardiac rehabilitation enrollment among patients across 20 states in 2013. It found that only 34% of patients with heart failure used rehab that year. A 2015 analysis of heart attack survivors in four states found 36% were enrolled in such programs.
"These estimates highlight missed opportunities to access an evidenced-based intervention that has been documented to improve patient survival, quality of life, functional status, and cardiovascular risk profile following a significant health event, as well as reduce risk for a recurrent heart attack and psychological disorders," the authors wrote.
Low participation in cardiac rehab is a constant challenge for many healthcare providers. The American Heart Association estimates 30% of the more than 915,000 Americans who experience a heart attack annually will have a second event, which increases the risk of fatality and makes treatment most costly.
About $1 out of every $6 spent on healthcare in the U.S., is spent on cardiovascular disease, according to the CDC, totaling more than $320 million a year in direct medical costs and lost productivity.
Figures from the National Bureau of Economic Research show health insurers pay on average more than $38,000 for care provided in the first 90 days following a heart attack, while Medicare spends about $14,000 per patient on hospital bills over the course of year following an attack. Both amounts rise about 4% a year.
Studies have shown cardiac rehab programs result in a 26% decline in mortality, and can decrease hospital admissions by 31% compared to cardiac patients who don't enroll in a rehab program. Cardiac rehab has been associated with a 25% reduction in the risk of long-term readmission and hospital savings of $900 per patient.
A huge barrier for some patients is cost. Cardiac rehab usually happens three times a week in two-hour sessions for an average of 36 sessions where patients receive an evaluation, an exercise routine, counseling on nutrition and diet, and help to get patient back to doing normal activities.
While Medicare and most private health plans cover cardiac rehab, co-pays for each session might scare off some patients.
"If you have to pay $20 or $30 every time you go to these 36 visits for cardiac rehab that amounts to quite a significant amount of money," said Dr. Martha Gulati, professor of nedicine and chief of the cardiology division at the University of Arizona at Phoenix.
A possible solution, Gulati said, would be for the Affordable Care Act to be amended so that the cost of secondary prevention services such as cardiac rehab was covered like other preventive-care services are.
Dr. Randal Thomas, a cardiologist at the Mayo Clinic, suggests another option; setting up an automatic referral system at the point of clinical care. Thomas said also having a liaison or coach to help patients with problems such as costs or transportation can help increase patient participation. He said the combination of automatic referral and a liaison has been show to increase participation rates to as high as 70% in programs.
Experts say clinicians are very influential in their patients decisions.
"Some of the problem of why people don't go to cardiac rehab is that it's under-referred," Galati said. "From a physician's standpoint, we underutilize it."
