Factors Associated With Utilization of Cardiac Rehabilitation Among Patients With Ischemic Heart Disease in the Veterans Health Administration

Schopfer, David W.; Priano, Susan M.; Allsup, Kelly; Helfrich, Christian D.; Ho, P. Michael; Rumsfeld, John S.; Forman, Daniel E.; Whooley, Mary A.

doi:10.1097/hcr.0000000000000166

Cited by 29 publications

(22 citation statements)

References 38 publications

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“…Transportation and travel issues can be of particular burden to older patients who are less able to drive long distances necessary to participate in traditional facility-based programs. [87][88][89] A burgeoning concept of home-based and hybrid CR programs aims to bridge a gap between patients willing and able to participate in facility-based programs and who are limited by logistics or other impediments. However, they have yet to be well-studied in patients with HF and important questions and concerns remain regarding whether CR is safe and effective at home for older patients with HF, and whether it will be reimbursed.…”

Section: Challengesmentioning

confidence: 99%

Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure

Schopfer

Forman

2016

Journal of Cardiac Failure

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Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with heart failure (HF). Prevalence of HF is increasingly common among older adults. Mounting effects of cardiovascular risk factors in older age as well as the added effects of geriatric syndromes such as multimorbidity, frailty, and sedentariness contribute to the high incidence of HF as well as to management difficulty. CR can play a decisive role in improving function, quality of life, symptoms, morbidity, and mortality, and also address the idiosyncratic complexities of care that often arise in old age. Unfortunately, the current policies and practices regarding CR for patients with HF are limited to HF with reduced ejection fraction and do not extend to HF with preserved ejection fraction, which is likely undercutting its full potential to improve care for today's aging population. Despite the strong rationale for CR on important clinical outcomes, it remains underused, particularly among older patients with HF. In this review, we discuss both the potential and the limitations of contemporary CR for older adults with HF.

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Section: Challengesmentioning

confidence: 99%

Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure

Schopfer

Forman

2016

Journal of Cardiac Failure

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“…This is particularly relevant in light of the fact that most VA medical centers do not have on-site CR programs, necessitating referral to non-VA programs. 7,8 In addition, a qualitative study 25 looking at barriers to CR participation in the VA found that the most common reason for refusal was patient transportation issues. Because there is discussion around expanding community care in the VA alongside the impetus to increase CR participation, our research can help inform both practitioner and patient decisions around referral to CR.…”

Section: Discussionmentioning

confidence: 99%

Association of Cardiac Rehabilitation With Survival Among US Veterans

et al. 2020

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IMPORTANCE Participation in cardiac rehabilitation (CR) programs at Veterans Affairs (VA) facilities is low. Most veterans receive CR through purchased care at non-VA programs. However, limited literature exists on the comparison of outcomes between VA and non-VA CR programs. OBJECTIVE To compare 1-year mortality and 1-year readmission rates for myocardial infarction or coronary revascularization between VA vs non-VA CR participants. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 7320 patients hospitalized for myocardial infarction or coronary revascularization at the VA between 2010 and 2014 who did not die within 30 days of discharge and who participated in 2 or more CR sessions after discharge. The study excluded individuals hospitalized for ischemic heart disease after December 2014 when the VA Choice Act changed referral criteria for non-VA care. Data analysis was performed from November 2019 to January 2020. EXPOSURES Participation in 2 or more CR sessions within 12 months of discharge at a VA or non-VA facility. MAIN OUTCOMES AND MEASURES The 1-year all-cause mortality and 1-year readmission rates for myocardial infarction or coronary revascularization from date of discharge were compared between VA vs non-VA CR participants using Cox proportional hazards models with inverse probability treatment weighting. RESULTS The 7320 veterans with ischemic heart disease who participated in CR programs had a mean (SD) age of 65.13 (8.17) years and were predominantly white (6005 patients [82.0%]), non-Hispanic (6642 patients [91.0%]), and male (7191 patients [98.2%]). Among these 7320 veterans, 2921 (39.9%) attended a VA facility, and 4399 (60.1%) attended a non-VA CR facility. Black and Hispanic veterans were more likely to attend CR programs at VA facilities (509 patients [17.4%] and 378 patients [12.9%], respectively), whereas white veterans were more likely to attend CR programs at non-VA facilities (3759 patients [85.5%]). After inverse probability treatment weighting, rates of 1-year mortality were 1.7% among VA CR participants vs 1.3% among non-VA CR participants (hazard ratio, 1.32; 95% CI, 0.90-1.94; P = .15). Rates of readmission for myocardial infarction or revascularization during the 12 months after discharge were 4.9% among VA CR participants vs 4.4% among non-VA CR participants (hazard ratio, 1.06; 95% CI, 0.83-1.35; P = .62). CONCLUSIONS AND RELEVANCE These findings suggest that rates of 1-year mortality and 1-year readmission for myocardial infarction or revascularization did not differ for participants in VA vs non-VA cardiac rehabilitation programs. Eligible patients with ischemic heart disease should participate in CR programs regardless of where they are provided.

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“…Other studies, including those from the physician perspective, have highlighted the importance of their encouragement on CR attendance as well. 13,[25][26][27] Moreover, the center where the study was undertaken is the main cardiac center in the southeast of Iran, so not only local, but nonlocal patients attend this center for treatment. In low-resource settings such as this, it is then important for cardiologists to advocate 28 for regional CR planning, including more capacity so they have spots to which they can refer their patients, as well as alternative models of delivery (eg, home-based, exploiting technology to optimize efficiency and hence increase capacity).…”

Section: Discussionmentioning

confidence: 99%

“…In the qualitative study by Schopfer et al 27 on factors affecting CR attendance, lack of CR information during medical education was one of the barriers identified. This is important as a previous study by Dahhan showed that an increase in physician awareness was associated with increased referral (from 17.6% to 88.96%).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Specialists’ Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting

Ghanbari-Firoozabadi

Mirzaei

Nasiriani

et al. 2020

Rehabilitation Process and Outcome

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Background: Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively. Aim: This study investigated cardiac specialists’ perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral. Methods: In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group. Results: Four themes emerged: “physician factors,” “center factors,” “patient factors,” and “cultural factors.” Regarding “physician factors,” most participants mentioned shortage of time. Regarding “center factors,” most participants mentioned poor physician-patient-center coordination. In “patient factors,” the subcategories that arose were socioeconomic challenges and clinical condition of the patients. “Cultural factors” related to lack of belief in behavioral/preventive medicine. Conclusions: Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.

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Factors Associated With Utilization of Cardiac Rehabilitation Among Patients With Ischemic Heart Disease in the Veterans Health Administration

Abstract: Our findings suggest that addressing access issues and educating and activating providers on CR may increase utilization of CR programs. Targeting these specific factors may improve utilization of CR programs.

Cited by 29 publications

References 38 publications

Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure

Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure

Association of Cardiac Rehabilitation With Survival Among US Veterans

Cardiac Specialists’ Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting

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