06:51am Sunday 23 February 2020

Cardiac rehab underused; healthcare reform law should help reduce barriers

DALLAS, Nov.  — Cardiac rehabilitation should be included in the implementation of the Patient Protection and Affordable Care Act (ACA) to help eliminate barriers for patients, such as women and minorities, according to an American Heart Association science advisory published in Circulation: Journal of the American Heart Association.  Despite scientific evidence of its benefits, only an estimated 14 to 35 percent of eligible patients participate in these programs.
“The advisory identifies those obstacles that studies have shown keep people from receiving cardiac rehab,” said Gary J. Balady, M.D., chair of the advisory’s writing group and director of preventive cardiology at Boston Medical Center and professor of medicine at Boston University School of Medicine. “Healthcare reform has great potential to address some of those barriers, and we encourage policymakers implementing the law to adopt the recommendations.”
Cardiac rehab is a professionally supervised program that can improve heart health and increase survival after heart attack, heart surgery or other procedures such as stenting and angioplasty. It teaches patients how to reduce risk factors for cardiovascular disease, such as high blood pressure, smoking, diabetes and others, by becoming more physically active and eating healthier. It also helps people cope with emotional issues such as the depression and anxiety that can follow a cardiac event or diagnosis.  
Women, minorities and people with lower socioeconomic status are the least likely to have access to cardiac rehab because of lack of insurance coverage, inability to pay insurance co-pays, language, transportation and other barriers. 
Fortunately, there are parts of ACA that have the potential to reduce barriers for patients, and these opportunities are outlined in the science advisory. Although the ACA is now law, implementation is still in its early stages.
Balady and colleagues identified major barriers to patients using cardiac rehab and how the ACA could address the hurdles. For example:
  • Financial barriers. Requiring coverage for cardiac rehab under the Essential Health Care Benefits Package that Qualified Health Plans, as defined by the Department of Health and Human Services, will have to cover could make cardiac rehab more available and affordable. Some insurance companies don’t cover cardiac rehab and many patients can’t afford the co-pays even if their insurance covers rehab. 
  • Referral barriers. Provisions in the ACA include the creation of “accountable care organizations” and incentives that may help coordinate care to keep patients healthier and decrease their need to be re-admitted to hospitals. Studies show that some healthcare providers may not be prescribing cardiac rehab, educating patients about its importance or following up on their patients’ outcomes. Women, the elderly, racial and ethnic minorities and people of lower socioeconomic status are among the least likely to be referred for cardiac rehab.
  • Access barriers. The Centers for Medicare and Medicaid Innovations, created under the reform law, provides funding to test new and innovative models of care delivery, such as telemedicine, that could be used to address some of these barriers. This could assist the people who are referred to cardiac rehab who can’t participate because of time, location, hours of operation or other obligations.
“Internet-based interventions have the potential to reduce at least two of these major barriers including cost and accessibility,” Balady said. “They provide ongoing feedback to both patients and doctors about risk‐factor control in the home environment and document program outcomes to help enhance involvement and adherence.”
Increasing participation in cardiac rehab is central to the American Heart Association’s 2020 goal to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent by the year 2020.
Regardless of what happens with healthcare reform, we have to get the word out to people who have heart disease that cardiac rehab saves lives, reduces heart disease risk factors and risk of subsequent heart attacks,” Balady said. “Ask your healthcare provider if you are a candidate for cardiac rehab.”
Co-authors of the advisory are: Philip A. Ades, M.D.; Vera Bittner, M.D.; Barry Franklin, Ph.D.; Neil F. Gordon, M.D., Ph.D., M.P.H.; Randal J. Thomas, M.D.; Gordon F. Tomaselli, M.D.; and Clyde Yancy, M.D.
Author disclosures and sources of funding are on the manuscript.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position.  The association makes no representation or guarantee as to their accuracy or reliability.  The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding External link.
 NR10 – 1151 (Balady)
Additional resources available on the right column.
For Media Inquiries:
Retha Sherrod – (202) 785-7929; Retha.Sherrod@heart.org
Darcy Spitz – (212) 878-5940; Darcy.Spitz@heart.org

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