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Cardiac Rehabilitation Utilization During an Acute Cardiac Hospitalization


Pack, Quinn R., MD, MSc; Priya, Aruna, MA, MSc; Lagu, Tara, MD, MPH; Pekow, Penelope S., PhD; Berry, Robert, MS; Atreya, Auras R., MD, MPH; Ades, Philip A., MD; Lindenauer, Peter K., MD, MSc

Journal of Cardiopulmonary Rehabilitation and Prevention: January 2019 - Volume 39 - Issue 1 - p 19–26
doi: 10.1097/HCR.0000000000000374
Cardiac Rehabilitation

Background: Inpatient cardiac rehabilitation (ICR) programs provide important services to hospitalized patients by delivering risk factor education, daily ambulation, and facilitation of referral to outpatient cardiac rehabilitation. However, little is known about ICR utilization or practice patterns.

Methods: We examined the use of ICR, between January 2007 and June 2011, in a geographically and structurally diverse sample of US hospitals (Premier, Inc).

Results: Among 458 hospitals, there were 1 343 537 admissions with a qualifying diagnosis for outpatient cardiac rehabilitation. Formal ICR was available at 223 (49%) of these hospitals. Overall, patient utilization of ICR was low (21.2%) and varied by indication. Utilization was highest in those undergoing cardiac surgery (43.3%) and lowest in patients with medically managed myocardial infarction (15.6%) or heart failure (10.6%). A larger bed count, the presence of cardiac interventional services, and Midwest location were associated with increased likelihood of a hospital having an ICR program. In multivariable hierarchical analysis adjusting for known hospital characteristics among hospitals that provided ICR, multiple patient factors were associated with a lower likelihood of ICR utilization, including older age, more comorbidities, female sex, and Medicare insurance, but unspecified hospital characteristics explained the vast majority of the variability.

Conclusions: We found substantial variation in the delivery of ICR across US hospitals and by patient condition. Overall, only a minority of eligible patients ever received ICR and fewer than half of hospitals treating cardiac patients provided formal ICR services. This substantial gap in the secondary prevention of heart disease warrants further investigation and intervention.

The use of inpatient cardiac rehabilitation was evaluated in a sample of 458 hospitals across the United States. We found that only 21% of potentially eligible patients ever received inpatient cardiac rehabilitation and that most of this variability was due to the hospital where the patients received their care.

Division of Cardiovascular Medicine (Drs Pack and Atreya and Mr Berry), Department of Internal Medicine (Drs Pack, Lagu, and Lindenauer), and Institute for Healthcare Delivery and Population Science (Drs Pack, Lagu, Pekow, and Lindenauer and Ms Priya), Baystate Medical Center, Springfield, Massachusetts; University of Massachusetts Medical School at Baystate, Springfield (Drs Pack, Lagu, and Lindenauer); School of Public Health and Health Sciences, University of Massachusetts, Amherst (Ms Priya and Dr Pekow); Division of Preventive Cardiology, Henry Ford Hospital, Detroit, Michigan (Mr Berry); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (Dr Atreya); and Division of Cardiology, Department of Medicine, The University of Vermont, Burlington (Dr Ades).

Correspondence: Quinn R. Pack, MD, MSc, Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01089 (

The authors declare no conflicts of interest.

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