ACC, AHA push for legislation that would expand access to cardiac rehab programs

Both the American College of Cardiology and the American Heart Association voiced their public support this week for legislation that would expand access to cardiac and pulmonary rehabilitation services in the U.S.

The Increasing Access to Quality Cardiac Rehabilitation Act of 2019, introduced in the House by Representatives John Lewis (D-GA) and Adrian Smith (R-NE), looks to increase the accessibility of cardiac rehab for heart patients, who studies have found directly benefit from rehabilitation but rarely show up.

The new legislation builds on last year’s Improving Access to Cardiac and Pulmonary Rehabilitation Act of 2018—an act that passed and enabled advanced practice providers (APPs) to supervise cardiac rehab services under Medicare starting in 2024. Right now, under federal law, only physicians are authorized to refer Medicare patients to cardiac or pulmonary rehabilitation, despite the fact that qualified nurse practitioners, physician assistants and clinical nurse specialists are often authorized to do so under state law. 

The Increasing Access to Quality Cardiac Rehabilitation Act would move last year’s deadline up five years, allowing APPs to supervise rehabilitation starting in 2019.

“These important services help reduce heart disease-related mortality and readmissions following a cardiac event, like a heart attack, heart surgery or a hospital admission for heart failure,” the ACC wrote in a statement Nov. 13. “The ACC is committed to not only owning this problem but advancing solutions, and allowing advanced practice practitioners to supervise and refer patients to cardiac rehab is one of those solutions.”

The AHA also chimed in, with CEO Nancy Brown issuing a statement Nov. 13 and noting that Congress took a “major step” last year when it included provisions in the Bipartisan Budget Act that authorized APPs to supervise rehabilitation care. But, she said, it’s a long wait until 2024. Patients are facing extensive wait times in receiving referrals for cardiac rehab, and the longer they wait, the less likely they are to enroll.

Research suggests women are already 12% less likely to be referred for rehabilitation than men, and black, Hispanic and Asian patients are 20%, 36% and 50% less likely, respectively, to be referred than white patients. Despite the established benefits of cardiac and pulmonary rehab, Brown said, participation remains very low.

“The steps this legislation takes would bridge the gap between referral and the start of [rehabilitation], and help patients access proven services to help improve their health outcomes,” she wrote. “This legislation extends upon previous legislative victories to help wipe out the burden of heart disease and stroke in our nation.”