The Centers for Medicare & Medicaid Services (CMS) expanded its coverage for cardiac rehabilitation services to include patients with chronic heart failure (HF) after determining that rehab is safe and effective.

“With the accumulated evidence that supports the benefits of the individual components of cardiac rehabilitation programs, the evidence is sufficient to determine that participation in these multicomponent programs improves health outcomes for Medicare beneficiaries with stable, chronic heart failure,” the agency wrote in its announcement.

In 2009, CMS 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 officials 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.

CMS is using the inclusion-exclusion criteria from HF-ACTION as a guide for patient selection in the Medicare population. Coverage is expanded to beneficiaries with stable, chronic heart failure, which it defined as patients with left ventricular ejection fraction of 35 percent or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least six weeks. It defined stable as patients with no recent or planned major cardiovascular hospitalizations or procedures.

CMS also recommended cardiac rehabilitation programs exclude patients with major comorbidities, limitations that interfere with exercise training and NYHA class IV heart failure. Major comorbidities and limitations were exclusion criteria in HF-ACTION. Only 23 of the 2,331 participants in the trial were NYHA class IV, making evidence for this subgroup of patients limited, CMS wrote.