Abstract 19209: Utilization of Inpatient Cardiac Rehabilitation During a Hospitalization for a Cardiac Condition: A National Sample

Introduction: Inpatient cardiac rehabilitation (ICR) programs provide important services to patients, including daily ambulation, risk factor education, and coordinated referral to outpatient cardiac rehabilitation. However, little is known about national current utilization or practice patterns. Methods: Utilizing a geographically and structurally diverse sample of US hospitals (PREMIER data warehouse, Inc.) we examined the use of ICR using detailed administrative data from January 2007 to June 2011. Patients with an ICD-9 principal diagnosis of myocardial infarction (MI) or heart failure (HF), or with a procedure code for coronary artery bypass surgery (CABG), valve (V) surgery, or percutaneous coronary intervention (PCI) were included. Any patient with ≥ 1 service code for ICR was considered to have received ICR. Results: We evaluated 1,343,537 qualifying admissions from 458 hospitals. The overall ICR utilization rate was 20.8%. ICR utilization was highest in patients with surgical procedures with 45.5%, 37.0%, 40.7% for CABG, V, CABG+V, with rates of 23.7%, 31.3%, 23.7%, 15.6%, and 10.6% for elective PCI, urgent PCI, MI + PCI, MI alone, and HF respectively. Of 458 hospitals, 223 (49%) hospitals provided any ICR, with a median (10-90%) hospital ICR rate of 18.8% (0.06% - 74.1%). Hospitals in urban areas had significantly higher rates of ICR compared to hospitals in rural areas (30.1% vs. 18.6%) as did hospitals with presence of interventional services (surgical services: 31.5% vs. 20.2%, p = 0.006; PCI services: 30.3% vs. 14.7%, p =0.003). Conclusions: There appears to be substantial variation in the delivery of ICR across US hospitals. Less than half of hospitals with cardiac patients provide ICR and only a minority of patients ever receives ICR. This substantial gap in the secondary prevention of heart disease appears to warrant further investigation and intervention.

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Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.006572 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

Dana R. Fletcher ◽

Gary K. Grunwald ◽

Catherine Battaglia ◽

P. Michael Ho ◽

Richard C. Lindrooth ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Time Window ◽

Artery Bypass ◽

Cost Effective ◽

Coronary Intervention ◽

Guideline Recommendation ◽

Annual Growth Rate ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Percentage Points

Background: Although cardiac rehabilitation (CR) is a Class I Guideline recommendation, and has been shown to be a cost-effective intervention after a cardiac event, it has been reimbursed at levels insufficient to cover hospital operating costs. In January 2011, Medicare increased payment for CR in hospital outpatient settings by ≈180%. We evaluated the association between this payment increase and participation in CR of eligible Medicare beneficiaries to better understand the relationship between reimbursement policy and CR utilization. Methods: From a 5% Medicare claims sample, we identified patients with acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, or cardiac valve surgery between January 1, 2009 and September 30, 2012, alive 30 days after their event, with continuous enrollment in Medicare fee-for-service, Part A/B for 4 months. Trends and changes in CR participation were estimated using an interrupted time series approach with a hierarchical logistic model, hospital random intercepts, adjusted for patient, hospital, market, and seasonality factors. Estimates were expressed using average marginal effects on a percent scale. Results: Among 76 695 eligible patients, average annual CR participation was 19.5% overall. In the period before payment increase, adjusted annual participation grew by 1.1 percentage points (95% CI, 0.48–2.4). No immediate change occurred in CR participation when the new payment was implemented. In the period after payment increase, on average, 20% of patients participated in CR annually. The annual growth rate in CR participation slowed in the post-period by 1.3 percentage points (95% CI, −2.4 to −0.12) compared with the prior period. Results were somewhat sensitive to time window variations. Conclusions: The 2011 increase in Medicare reimbursement for CR was not associated with an increase in participation. Future studies should evaluate whether payment did not reach a threshold to incentivize hospitals or if hospitals were not sensitive to reimbursement changes.

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Abstract 134: Implementation of Home-Based Cardiac Rehabilitation in the VA

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.134 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

David W Schopfer ◽

Nirupama Krishnamurthi ◽

Hui Shen ◽

Mary A Whooley

Keyword(s):

Cardiac Rehabilitation ◽

Artery Bypass ◽

Coronary Intervention ◽

The United States ◽

Medical Centers ◽

The United Kingdom ◽

Home Based ◽

Percutaneous Coronary ◽

The Us ◽

Va Hospitals

Objective: Referral to cardiac rehabilitation (CR) is one of nine performance measures for patients with ischemic heart disease (IHD), but fewer than 20% of eligible patients participate in the United States. Home-based CR programs (available in the United Kingdom, Australia, and Canada) have similar effects on morbidity and mortality as traditional (facility-based) CR, but they are not currently available or reimbursed in the US. We sought to determine whether implementing home-based programs could increase CR participation among patients with IHD. Methods: Using electronic health records from 134 VA medical centers, we identified 106,277 veterans hospitalized for acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting between 2010 and 2015. We compared the proportion of eligible patients who participated in CR at 13 VA hospitals that offered referral to either home-based CR or facility-based CR vs. 121 VA hospitals that offered referral to only facility-based CR (usual care). Results: The number of VA medical centers offering home-based CR increased from 2 in 2010 to 13 in 2015. Among the 20,949 eligible patients hospitalized at VA medical centers that implemented home-based CR between 2010 and 2015, CR participation increased from 11% to 26% (Figure). Among the 85,328 eligible patients hospitalized at VA medical centers that did not offer home-based CR, CR participation increased from only 8% to 11%. Conclusion: Among eligible patients with IHD, participation in CR more than doubled at VA medical centers that implemented home-based CR programs between 2010 and 2015, whereas participation increased by only 3% at VA medical centers that did not implement home-based CR programs. Home-based CR is an effective way of engaging patients who may otherwise decline to participate in CR.

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Examining calorie undernourishment in India: Is it due to choice or inadequacy?

Nutrition and Health ◽

10.1177/0260106020949739 ◽

2020 ◽

pp. 026010602094973

Author(s):

Udaya S Mishra ◽

Balakrushna Padhi ◽

Rinju

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Urban Poor ◽

Food Choices ◽

National Sample ◽

Sample Survey ◽

The Poor ◽

Food Expenditure ◽

Lower Magnitude ◽

Common Understanding

Background: Calorie undernourishment is often associated with poverty but India presents a unique scene of decline in money-metric poverty and rise in calorie deprivation. Existing literature has varied explanation towards this effect. However, neither are the poor entirely calorie compromised nor do all the non-poor qualify calorie compliance. Aim: This is an attempt at verifying whether calorie undernourishment is a result of choice of food basket or the inadequacy of food expenditure. Method: An answer to this question is attempted with the exploration of data obtained from the National Sample Survey Organization’s Consumption Expenditure of Indian households for the periods 2004–2005 and 2011–2012. Results: Findings reveal that over the last one decade, the average per capita per day calorie intakes have slightly increased from 2040.55 Kcal in 2004–2005 to 2087.33 Kcal in 2011–2012, which has led to the increased share of well-nourished households from 20.21% in the 61st round to 22.78% in the 68th round of survey in rural areas, whereas the similar increase in urban areas is from 36.1% to 40.65%. Conclusions: Calorie undernourishment among the non-poor is observed that calorie undernourishment, if any, among the non-poor is entirely due to choice but the same among the poor has a divide between choice and inadequacy. The urban poor are calorie compromised more due to choice rather than inadequacy as against their rural counterparts. With higher poverty, calorie, non-compliance among the poor is more due to choice when compared with lower magnitude of poverty. These observations form a basis for contesting the common understanding that calorie compromise is entirely driven by inadequacy/incapacity of food expenditure. could be viewed in terms of the food choices made, especially among the poor while setting the minimum threshold of food expenditure to be calorie compliant.

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Return to work: does cardiac rehabilitation make a difference? Danish nationwide register-based study

Scandinavian Journal of Public Health ◽

10.1177/14034948211062656 ◽

2021 ◽

pp. 140349482110626

Author(s):

Sasja Maria Pedersen ◽

Marie Kruse ◽

Ann Dorthe O. Zwisler ◽

Charlotte Helmark ◽

Susanne S. Pedersen ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Artery Bypass ◽

Emergency Admission ◽

Coronary Intervention ◽

Lower Probability ◽

Main Diagnosis ◽

Exact Matching ◽

Logistic Regression Models ◽

Icd 10 ◽

Returning To Work

Aim: to assess whether participation in cardiac rehabilitation affects the probability of returning to work after ischaemic heart disease. Methods: the study population consisted of 24,509 patients (18–70 years of age) discharged from an inpatient admission at a Danish hospital during 2014–2018 and who were working before their admission. Only patients with a percutaneous coronary intervention or coronary artery bypass grafting surgery procedure and ICD-10 codes I20–I25 as their main diagnosis or ICD-10 codes I21, I240, I248 or I249 as secondary diagnosis during an emergency admission were included. Exposure was defined as participation in cardiac rehabilitation ( N = 15,742), and binary indicator of being at work in the last week of a given month were used as primary outcomes. Coarsened exact matching (CEM) of exposed and unexposed patients was used to reduce selection bias. Logistic regression models were applied on the matched population ( N = 15,762). Results: Less deprived and less comorbid patients were more likely to receive cardiac rehabilitation. CEM succeeded in arriving at a population where this selection was reduced and in this population we found that patients who received cardiac rehabilitation had a lower probability of returning to work after 3 months (OR 0.81, 95%CI: 0.77–0.84), a higher but insignificant probability after 6 (OR 1.02, 95%CI: 0.97–1.08), and a higher probability after 9 (OR 1.08, 95%CI: 1.02–1.15) and 12 months (OR 1.20, 95%CI: 1.13–1.28). Conclusions: Deprived and comorbid patients have lower use of cardiac rehabilitation. In a matched population where this bias is reduced, cardiac rehabilitation will increase the probability of returning to work.

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Abstract P323: Cardiac Rehabilitation is Associated With Decreased Mortality in HIV Patients With Cardiovascular Disease

Circulation ◽

10.1161/circ.135.suppl_1.p323 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Justin M Bachmann ◽

Suman Kundu ◽

Kaku So-Armah ◽

Amy Justice ◽

Jason Sico ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiac Rehabilitation ◽

Artery Bypass ◽

Coronary Intervention ◽

Hiv Status ◽

Hiv Patients ◽

Risk Of Mortality ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

One Year

Background: Human immunodeficiency virus (HIV+) patients are at high risk for cardiovascular disease (CVD). While cardiac rehabilitation (CR) reduces mortality in uninfected (HIV-) patients with CVD, there are no specific data on CR use in CVD patients with HIV. Methods: We analyzed data on 7650 veterans (28.4% HIV+) eligible for CR from the Veterans Aging Cohort Study, an observational cohort of HIV+ and HIV- veterans. CR eligibility was defined as a hospitalization for acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or cardiac valve surgery from 2003-2012, identified using ICD9 and CPT codes. CR use was ascertained from VA and non-VA facilities within one year of discharge from the index CVD hospitalization using CPT codes. We evaluated the association between CR and mortality after adjusting for age, eligibility diagnosis, race, sex, and comorbidities using Cox proportional hazard models. Results: CR use was low in HIV+ and HIV- veterans (9.1% vs. 9.6%, respectively, p=0.06). Among the 7650 CR eligible veterans, there were 2211 deaths over 25,715 person-years of follow-up. Mortality rates were higher among those who did not receive CR, regardless of HIV status (Figure). In adjusted models stratified by HIV status, CR was associated with a significant reduction in mortality for HIV+ (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.26-0.59) and HIV- veterans (HR 0.52, 95% CI 0.42-0.65). Among those receiving CR, HIV was not associated with an increased risk of mortality (Figure) even after adjusting for confounders (HR 1.01, 95% CI 0.63-1.61). Conclusions: CR utilization in both HIV+ and HIV- veterans is low. Participation in CR programs is associated with a significant reduction in mortality, regardless of HIV status. When CR is utilized, however, the risk of mortality is the same for HIV+ and HIV- veterans. CR may be particularly important for reducing mortality in HIV+ patients with CVD.

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Mobility in India: Recent Trends and Issues Concerning Database

Social Change ◽

10.1177/0049085718800892 ◽

2018 ◽

Vol 48 (4) ◽

pp. 634-644

Author(s):

Amitabh Kundu

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Population Distribution ◽

National Sample ◽

Sample Survey ◽

Age Cohorts ◽

Passenger Traffic ◽

Social Divisions ◽

The People ◽

Recent Trends

Dismissing the postulate that the geographical, linguistic and other social divisions are constraining the movement of Indians across states, researchers have presented evidences—pattern of rail passenger traffic, changes in population distribution across different age cohorts and so on to show that the movement of people across states is much larger than what has been generally determined, using the data from the census and National Sample Survey. The basic objective of the paper is to examine if the process of migration and urbanisation in India is indeed unconstrained so that the people in backward regions and rural areas, who get dispossessed of their livelihood options or social linkages, can freely move into the developed regions or urban areas, It analyses these processes and recent trends while probing into methodological and data related issues in migration studies in India. The migration trends for socio-economically vulnerable sections of population are presented in the context of their access to urban and metropolitan space.

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Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17217944 ◽

2020 ◽

Vol 17 (21) ◽

pp. 7944

Author(s):

Hassan N. Moafa ◽

Sander Martijn Job van Kuijk ◽

Dhafer M. Alqahtani ◽

Mohammed E. Moukhyer ◽

Harm R. Haak

Keyword(s):

Saudi Arabia ◽

Emergency Medical Services ◽

Central Region ◽

Rural Areas ◽

Urban Areas ◽

Medical Services ◽

Utilization Rate ◽

Rural And Urban Areas ◽

Emergency Medical ◽

Rural And Urban

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20′ target, reorganizing the lowest urgent cases in the rural areas seems necessary.

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A nationwide survey on participation in cardiac rehabilitation among patients with coronary heart disease using health claims data in Japan

Scientific Reports ◽

10.1038/s41598-021-99516-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shosuke Ohtera ◽

Genta Kato ◽

Hiroaki Ueshima ◽

Yukiko Mori ◽

Yuka Nakatani ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cardiac Rehabilitation ◽

Artery Bypass ◽

Nationwide Survey ◽

Coronary Intervention ◽

Health Claims ◽

National Database ◽

Nutritional Education ◽

Health Claims Data

AbstractPoor implementation and variable quality of cardiac rehabilitation (CR) for coronary heart disease (CHD) have been a global concern. This nationwide study aimed to clarify the implementation of and participation in CR among CHD patients and associated factors in Japan. We conducted a retrospective cohort study using data extracted from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in 2017–2018 were included. Aspects of CR were assessed in terms of (1) participation in exercise-based CR, (2) pharmacological education, and (3) nutritional education. Of 87,829 eligible patients, 32% had participated in exercise-based CR, with a mean program length of 40 ± 71 days. CABG was associated with higher CR participation compared to PCI (OR 10.2, 95% CI 9.6–10.8). Patients living in the Kyushu region were more likely to participate in CR (OR 2.59, 95% CI 2.39–2.81). Among patients who participated in CR, 92% received pharmacological education, whereas only 67% received nutritional education. In Japan, the implementation of CR for CHD is insufficient and involved varying personal, therapeutic, and geographical factors. CR implementation needs to be promoted in the future.

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Abstract 310: Neighborhood Socioeconomic Context Predicts Cardiac Rehabilitation Participation Above and Beyond Individual Socioeconomic Status

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.310 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Justin M Bachmann ◽

Loren Lipworth ◽

Thomas J Wang ◽

Michael T Mumma ◽

Mary A Whooley ◽

...

Keyword(s):

United States ◽

Socioeconomic Status ◽

Cohort Study ◽

Cardiac Rehabilitation ◽

Cox Regression ◽

Artery Bypass ◽

Coronary Intervention ◽

The United States ◽

Socioeconomic Context ◽

Percutaneous Coronary

Background: Cardiac rehabilitation (CR) is underutilized in the United States, with less than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but the effect of neighborhood socioeconomic context on CR use has not been described. We investigated the association of CR participation with neighborhood socioeconomic context in the Southern Community Cohort Study (SCCS). Methods: The SCCS is a prospective cohort study of 84,569 largely poor adults in the southeastern United States, of which 52,117 participants have Medicare or Medicaid claims. Using these claims data, we identified SCCS participants with hospitalizations for myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery or cardiac valve surgery and ascertained their CR utilization. Neighborhood socioeconomic context was assessed using a previously validated neighborhood deprivation index. This index was derived using 11 census-tract level variables including median household value and percentage of households with public assistance income. We used multivariable-adjusted logistic and Cox regression to evaluate the association of CR participation with neighborhood socioeconomic context and mortality. Results: A total of 4456 SCCS participants (56% female, 59% Black) were eligible for CR at a mean age of 60.5 + 9.1 years and an average of 4.0 + 2.5 years after study enrollment. CR utilization was low as expected, with 308 subjects (6.9%) participating in CR programs. CR participation is inversely associated with all-cause mortality (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.39-0.70, p=<0.0001) and cardiovascular disease (CVD) mortality (HR 0.38, 95% CI 0.22-0.65, p=<0.001) after multivariable adjustment. Neighborhood socioeconomic context is strongly associated with CR participation after adjustment for individual socioeconomic status (educational level and household income) as well as rural status (Table). Conclusions: Neighborhood socioeconomic context predicts CR participation in addition to individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities.

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