In a reversal from its 2009 opinion, the Centers for Medicare & Medicaid Services (CMS) is proposing to expand its coverage for cardiac rehabilitation services for patients with chronic heart failure.

In 2009, the agency rejected efforts to include cardiac rehabilitation for these patients, arguing that there was not sufficient evidence showing benefits. Results from trials such as HF-ACTION (A Controlled Trial Investigating Outcomes of Exercise Training) helped to persuade them to reassess the issue. In HF-ACTION, heart failure patients who exercised on a stationary bicycle or a treadmill for 25 to 30 minutes most days of the week modestly lowered their risk of hospitalization or death.

“As the criteria to identify patients who may benefit from CR [cardiac rehabilitation] have been better substantiated, the likelihood of improving health outcomes for a specific population has increased,” CMS explained in a memo. “CR programs focus not only on exercise intervention, but also on reducing behavioral risk factors such as promoting healthy diet and reducing tobacco use.  CR improves symptoms of chronic HF [heart failure], decreases mortality, and reduces hospitalization.”

CMS wrote that the evidence in support of cardiac rehabilitation is now compelling enough to warrant coverage for Medicare beneficiaries with chronic heart failure. It defined chronic heart failure as left ventricular ejection fraction of 35 percent or less and New York Heart Association class II to IV symptoms despite being on optimal heart failure therapy for at least six weeks. 

CMS is seeking comments on its proposed decision. Comments can be made here.