Gaps in Referral to Cardiac Rehabilitation of Patients Undergoing Percutaneous Coronary Intervention in the United States

Aragam, Krishna; Dai, Dadi; Neely, Megan L.; Bhatt, Deepak L.; Roe, Matthew T.; Rumsfeld, John S.; Gurm, Hitinder S.

doi:10.1016/j.jacc.2015.02.063

Cited by 143 publications

(128 citation statements)

References 38 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…CR participation rates are alarmingly low, particularly with respect to women and minorities 20. Aragam et al reported a minimal influence of patient demographic factors on rates of CR referral among patients with percutaneous coronary intervention 8. In our study, among eligible cardiovascular patients, we found that females were 15% less likely to receive CR referral than males.…”

Section: Discussioncontrasting

confidence: 42%

“…In our study, we showed that CR referral at hospital discharge was significantly associated with reduced mortality for women and minorities, a group of patients that have traditionally being understudied in the literature. Prior studies suggested that the most significant predictor and easily overcome barrier is the lack of CR referral at hospital discharge 8. We expanded upon prior study by assessing the degree to which the mortality disparity could be reduced by reducing inequality in CR referral at hospital discharge, using a causal mediation analysis approach.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac rehabilitation (CR), which emphasizes smoking cessation, physical activity, and weight management, can improve physical function, psychosocial well‐being, and quality of life for myocardial infarction (MI) survivors 4, 5, 6. Despite the many benefits of CR, referral and participation rates are surprisingly low 7, 8, 9. The Million Hearts Initiatives from the Centers for Disease Control and Prevention set a goal to achieve >70% participation in CR/secondary prevention programs by the year 2022 10.…”

Section: Introductionmentioning

confidence: 99%

“…Prior research on CR mainly focused on 2 areas: (1) identifying predictors for CR referral and initiation8, 9, 17, 18, 19, 20, 21 and (2) estimating the effects of CR participation with subsequent outcomes, such as mortality 22, 23, 24. For (1), the majority of evidence was collected from white males 25.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Fonarow

Mukamal

et al. 2018

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundCardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival.Methods and ResultsWe linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral.Conclusions CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.

show abstract

Section: Discussioncontrasting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Fonarow

Mukamal

et al. 2018

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Brown et al 32 extracted data from the American Heart Association's Get With The Guidelines program indicated that patients with comorbidity non-ST-segment elevation myocardial infarction, older age would have less chance to receive cardiac rehabilitation services. 32 Aragam et al 35 performed a study enrolling 1432399 patients at 1310 participating hospitals between 2009 and 2012 in the United State, which demonstrated only 60% patients after PCI received cardiac rehabilitation Aragam et al 35 Found that the rate of cardiac rehabilitation referral was associated with hospital characteristics, patient factors and insurance status; and the relevance of three factors gradually declined. All these factors could be overcome.…”

Section: Cardiac Rehabilitation After Pcimentioning

confidence: 99%

The Development of Antiplatelet Therapy after Percutaneous Coronary Intervention

Duan

Gong

2017

IPMRJ

View full text Add to dashboard Cite

Coronary artery disease is one of the common cardiovascular diseases and threatens our health. Percutaneous coronary intervention (PCI) is the main treatment for coronary artery disease. Bare-metal stents (BMS) and drug-eluting stents (DES) are popularly applied in clinical practice. With the development of clinic and technology, DES is widely used in coronary artery disease following antiplatelet therapy. Clinical guidelines require dual antiplatelet therapy (DAPT) after PCI in USA and Europe. It is effective to reduce the incident of stent thrombosis, myocardial infarction and major adverse cardiac. However, the risk of major adverse cardiac events and bleeding was increased by DAPT. Therefore, single antiplatelet therapy was induced in various clinical trials. We searched previous research from PubMed, Embase Web of Science

show abstract

Expanding Payment Reform in Medicare

Song

Blumenthal

2016

JAMA

View full text Add to dashboard Cite

Cardiovascular disease is the leading cause of death and disability in the United States, accounting for 1 in 4 deaths and more than $200 billion in direct and indirect costs annually. 1 In July 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a new episode-based payment model for myocardial infarction. This model aims to improve the quality and efficiency of cardiac care and helps move the United States toward CMS's goal of having 50% of traditional Medicare payments in valuebased models by 2018.Proposed to launch July 1, 2017, the cardiac payment model would provide hospitals with an episodebased payment covering the index hospitalization for acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery and care paid under Medicare Parts A or B for 90 days after discharge. 2 Hospitals will bear financial risk or receive rewards based on episode-level spending and quality-similar to "2-sided" population-based global payment contracts that reward accountable care organizations if spending is below budget and penalize them if spending exceeds the budget. Specifically, in the cardiac model, if spending is less than the episode-based amount, hospitals may keep a portion or all of the difference, provided they meet

show abstract

Gaps in Referral to Cardiac Rehabilitation of Patients Undergoing Percutaneous Coronary Intervention in the United States

Cited by 143 publications

References 38 publications

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

The Development of Antiplatelet Therapy after Percutaneous Coronary Intervention

Expanding Payment Reform in Medicare

Contact Info

Product

Resources

About