Table 1.
Cardiac Rehabilitation Eligibility, Participation, and Utilization Among Medicare Fee-for-Service Beneficiaries Aged ≥65 Years Who Had a Primary Qualifying Event Type, 2016–2017
| CR Eligible | Participation Among Eligible | Sessions Used Among Participants | |||||||
|---|---|---|---|---|---|---|---|---|---|
| N | Rate/1000 | N | % | aPR* (95% CI) | Mean No. of Sessions (SD) | ≥25 Sessions, % | ≥36 Sessions | ||
| % | aPR* (95% CI) | ||||||||
| Total | 366 103 | 13.0 | 89 327 | 24.4 | NA | 24.8 (12.0) | 56.7 | 26.9 | NA |
| 65–74 y | 151 392 | 10.0 | 48 037 | 31.7 | Referent | 24.8 (12.0) | 56.4 | 26.8 | Referent |
| 75–84 y | 134 699 | 15.6 | 33 436 | 24.8 | 0.93 (0.92–0.95) | 25.2 (11.8) | 57.9 | 27.6 | 1.08 (1.05–1.11) |
| ≥ 85 y | 80 012 | 18.0 | 7854 | 9.8 | 0.57 (0.56–0.59) | 23.6 (12.4) | 53.5 | 23.9 | 0.98 (0.93–1.03) |
| Sex | |||||||||
| Male | 207 911 | 16.9 | 59 462 | 28.6 | Referent | 25.4 (11.8) | 58.7 | 28.3 | Referent |
| Female | 158 192 | 10.0 | 29 865 | 18.9 | 0.91 (0.90–0.93) | 24.5 (12.2) | 56.5 | 26.1 | 0.87 (0.85–0.90) |
| Race-ethnicity | |||||||||
| Non-Hispanic white | 313 251 | 13.5 | 80 884 | 25.8 | Referent | 25.4 (11.9) | 56.4 | 26.8 | Referent |
| Non-Hispanic black | 22 865 | 11.0 | 3113 | 13.6 | 0.70 (0.67–0.72) | 24.4 (12.5) | 56.4 | 26.9 | 1.07 (1.00–1.14) |
| Hispanic | 16 182 | 11.1 | 2130 | 13.2 | 0.63 (0.61–0.66) | 23.1 (12.9) | 52.6 | 23.7 | 0.97 (0.89–1.06) |
| Asian | 6342 | 8.6 | 1033 | 16.3 | 0.80 (0.75–0.85) | 24.3 (12.6) | 55.6 | 26.3 | 1.06 (0.94–1.20) |
| Other/unknown | 7463 | 10.2 | 2167 | 29.0 | 0.96 (0.92–1.00) | 25.4 (11.8) | 58.7 | 27.5 | 1.00 (0.92–1.08) |
| Dual Medicare/Medicaid coverage | |||||||||
| No | 324 167 | 12.8 | 86 449 | 26.7 | Referent | 25.0 (11.9) | 57.2 | 27.2 | Referent |
| Yes | 41 936 | 14.9 | 2878 | 6.9 | 0.40 (0.39–0.42) | 19.6 (13.3) | 40.7 | 16.8 | 0.65 (0.59–0.71) |
| Comorbidities† | |||||||||
| 0–2 | 54 874 | 4.6 | 20 619 | 37.6 | Referent | 25.3 (11.8) | 57.5 | 29.0 | Referent |
| 3–4 | 108 397 | 11.9 | 33 634 | 31.0 | 1.01 (0.99–1.03) | 25.5 (11.7) | 58.8 | 28.0 | 0.97 (0.94–1.00) |
| 5–6 | 133 522 | 24.8 | 27 066 | 20.3 | 0.87 (0.85–0.88) | 24.4 (12.1) | 55.6 | 25.5 | 0.89 (0.86–0.92) |
| 7–9 | 69 310 | 37.0 | 8008 | 11.6 | 0.65 (0.63–0.67) | 22.5 (12.6) | 49.6 | 21.3 | 0.76 (0.72–0.80) |
| Chronic kidney disease‡ | |||||||||
| No | 138 877 | 6.9 | 44 883 | 32.3 | Referent | 25.2 (11.8) | 57.6 | 27.9 | Referent |
| Yes | 227 226 | 28.0 | 44 444 | 19.6 | 0.86 (0.85–0.87) | 24.4 (12.1) | 55.8 | 25.8 | 0.94 (0.91–0.96) |
| PAC use§ | |||||||||
| None | 322 843 | NA | 84 076 | 26.1 | Referent | 24.9 (11.9) | 53.7 | 25.5 | Referent |
| Any PAC use | 43 260 | NA | 5251 | 12.1 | 0.61 (0.60–0.63) | 25.1 (11.9) | 58.3 | 26.7 | 1.03 (0.98–1.09) |
| Home health only | 25 034 | NA | 3743 | 15.0 | 0.71 (0.68–0.73) | 25.1 (11.9) | 58.7 | 26.8 | 1.03 (0.96–1.09) |
| Any institutional PAC‖ | 18 226 | NA | 1508 | 8.3 | 0.46 (0.44–0.49) | 25.1 (12.0) | 57.4 | 26.5 | 1.04 (0.94–1.15) |
| Died >21 d of discharge | |||||||||
| No | 317 377 | NA | 88 494 | 27.9 | Referent | 24.9 (11.9) | 57.0 | 27.1 | Referent |
| Yes | 48 726 | NA | 833 | 1.7 | 0.11 (0.11–0.12) | 14.4 (11.5) | 22.9 | 5.6 | 0.22 (0.17–0.30) |
aPR indicates adjusted prevalence ratio; CR, cardiac rehabilitation; NA, not applicable; and PAC, post-acute care.
Adjusted, as appropriate, by age, sex, race-ethnicity, dual status, comorbidity count category, qualifying event type, and death status.
Count of the following: documented evidence of heart failure, atrial fibrillation, stroke/transient ischemic attack, endocrine or renal dysfunction, cancer, musculoskeletal or joint dysfunction, pulmonary dysfunction, cognitive or mental impairment, or ophthalmic dysfunction.
Covariates included in the adjusted model were modified by removing chronic kidney disease from one of the conditions included in the comorbidity count variable.
Covariates included in the adjusted model were modified by excluding qualifying event type because of collinearity with the PAC use variables.
Any use of a long-term care facility, skilled nursing facility, or inpatient rehabilitation facility with or without home health after the initial qualifying event occurred.