Cardiac Rehabilitation Referral and Participation Rates for Heart Failure With Reduced Ejection Fraction

Abstract

Cardiac Rehabilitation Referral and Participation Rates for Heart Failure With Reduced Ejection Fraction T American College of Cardiology/American Heart Association guidelines recommend exercise training (typically in a cardiac rehabilitation [CR] setting) to improve functional status in patients with symptomatic heart failure with reduced ejection fraction (HFrEF) able to participate (Class I recommendation, level of evidence A). To date, few studies have determined CR referral and enrollment rates in heart failure (HF) patients.1-4 These studies have found that CR referral and participation rates for HF patients are low (10.4% and 2.6-41%, respectively).1-4 A major barrier to CR referral was the lack of insurance coverage.5,6 In 2014, the Centers for Medicare & Medicaid Services (CMS) initiated coverage of CR for selected patients with HFrEF (ie, those who meet CMS referral criteria). It would be expected that the introduction of this CMS coverage would result in greater CR referral and participation rates. To this point, a previous study reported that CR participation rates were 41% in patients with HFrEF following CMS coverage3; however, referral rates were not reported. Other studies reporting CR referral and participation rates following CMS coverage approval have found low CR participation rates1,4; however, it is unclear whether these patients met CMS entry criteria for CR. Thus, we sought to assess CR referral, enrollment, and graduation rates in patients with HFrEF following introduction of CMS coverage for CR.