Within a year of hospital discharge, fewer than 25 percent of older adults who had an acute MI between 2007 and 2010 and were eligible for cardiac rehabilitation actually attended a session, according to an analysis of a national quality improvement registry.
After patients have an MI and leave the hospital, they typically are told to visit their primary care physicians and cardiologists and begin treatment with a few medications. Cardiac rehabilitation is another way for patients to have structured physical activity, according to lead researcher Jacob A. Doll, MD, of the Duke Clinical Research Institute in Durham, N.C.
Doll and his colleagues published their findings online in JAMA Internal Medicine on Aug. 3.
During cardiac rehabilitation sessions, patients exercise in a supervised fashion and receive education about the importance of taking their medications, staying active, having a good diet and keeping appointments with physicians. Doll said previous research found patients who participate in cardiac rehabilitation may live longer and have better outcomes.
A meta-analysis of 34 trials conducted between 1979 and 2010 that included 6,111 patients found there was around a 25 percent decrease in the rate of death among patients who participated in cardiac rehabilitation. Still, Doll added that another study from a decade ago found few patients were attending the sessions.
In the current study, the researchers identified 58,269 patients who were at least 65 years old and eligible for cardiac rehabilitation after having an MI between 2007 and 2010. At hospital discharge, 62.4 percent of patients were referred to cardiac rehabilitation. Of those patients who were referred, 32.6 percent attended a session within the next year, while 8.2 percent of patients who were not referred ended up attending a session within a year.
Overall, only 23.4 percent of the patients attended at least one cardiac rehabilitation session and 5.4 percent attended at least 36 sessions. In 2013, guidelines from the American College of Cardiology and American Heart Association recommended cardiac rehabilitation following acute MI.
“We thought that things had probably improved more than they actually had,” Doll told Cardiovascular Business. “There’s been a big push among hospitals to refer people to cardiac rehab to the point where it’s a quality measure in a lot of hospitals that every patient should be referred. To see, first of all, many patients not being referred and then probably more distressingly a lot of the referred patients not even making it to cardiac rehab really pointed out to us that referral is not enough. You need to also help patients to actually get to cardiac rehab and follow up down the line to make sure that they could get the treatment they need.”
Still, Doll admitted there are challenges. Although Medicare covers cardiac rehabilitation for 36 sessions, some patients still have to pay $10 to $20 co-payments per session, which could be costly. In addition, patients in rural settings may not have a cardiac rehabilitation session nearby and may have trouble getting to a session.
“It may be that you can never get 100 percent of these patients to go to traditional rehab centers,” Doll said. “We may need to look for other ways to deliver these kinds of programs for patients, either in the home or in non-traditional settings.”