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Only 10 percent of heart failure patients get referred for rehabilitation

August 24, 2015
Cardiology Population Health
By Frieda Wiley, Contributing Reporter

Only one-tenth of all patients with heart failure are referred to cardiac rehabilitation post hospital discharge — despite the Centers for Medicaid and Medicare Services’ having approved rehabilitation for eligible patients in 2013.


A new study in the Journal of the American College of Cardiology evaluated more than 105,619 heart failure patients between 2004 and 2014, and found that only 10.4 percent of patients eligible for treatment actually received referrals. Referral rates increased as the study progressed yet still remained categorically low.

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“Transition of care is the advantage to referral for cardiac management,” explained Dr. Gregg Fonarow, professor of Medicine, director of Ahmanson-UCLA Cardiomyopathy Center and co-director of UCLA Division of Cardiology, to HCB News.

“Cardiac rehabilitation is much more than [just] the exercise component,” Fonarow points out.

“Patients need to adhere to lifestyle modifications, [and they benefit from] heart failure disease management programs, medication adherence, monitoring daily weight, salt restriction, and understanding the disease. Patients also benefit from early contact with doctors and nurses,” said Fonarow.

The study also found that younger patients were three to four times more likely to receive treatment, although older patients showed greater improvement upon treatment. The apparent age-related disparity revealed in this study is not new to cardiology.

“We actually see that with a number of therapies — whether cardiac infarction, heart failure, etc. — physicians are less likely to refer the older patients even if they are more likely to benefit,” said Fonarow.

“Some [previous] studies have raised the issue of age-related bias in which physicians are less likely to refer older patients. It may be that there is a perception that older patients are less likely to want to participate in cardiac therapies, and clinical trials tend to enroll younger patients," he said.

Additional groups less likely to be referred for cardiac rehabilitation included women and people with varying co-morbidities. Researchers also found some differences in geographic location.

Race and ethnicity, however, did not prove to be a factor. “We found some modest differences in race and ethnicity, but after adjustments, they were no longer significant,” said Fonarow.

The study only included patients with stage C and D heart failure because, “Stage A and Stage B patients don’t really have heart failure,” Fonarow explained.

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