Trends in Cardiac Rehabilitation Participation Among Veterans and Medicare Beneficiaries With Stable Heart Failure, 2012 to 2022

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Abstract
Background: Heart failure (HF) affects 6.7 million American adults and is associated with significant morbidity and mortality. Cardiac rehabilitation (CR) is a behavior modification program recommended to improve health outcomes in patients with HF. In 2014, Medicare began covering facility‐based CR for patients with stable HF, and some Veterans Affairs (VA) facilities began offering home‐based CR. Methods: We conducted an observational study to assess CR participation among patients with stable HF and patient characteristics associated with participation. National electronic health record data from the VA and claims data from a 5% Medicare sample were used to identify patients using International Classification of Diseases, Ninth Revision ( ICD‐9 ) or Tenth Revision ( ICD‐10 ) codes. CR participation was determined using Current Procedural Terminology codes and VA stop codes during the 12 months following HF diagnosis. A multivariable logistic regression was constructed to identify patient characteristics associated with participation. Results: From 2012 to 2022, VA participation increased from 7.4% to 10.4% and Medicare decreased from 7.4% to 5.1%. From 2016 to 2022, 13.2% of veterans and 6.7% of Medicare beneficiaries with stable HF participated in CR. Older age, female sex, and non‐White race were associated with lower participation, and comorbid ischemic heart disease was associated with greater participation (odds ratio [OR], 1.48 [95% CI, 1.45–1.52] in VA; OR, 2.69 [95% CI, (2.62–2.78] in Medicare). Conclusions: Following the VA's implementation of home‐based CR and Medicare's facility‐based CR coverage for stable HF, participation increased among veterans but not among Medicare beneficiaries. Lower participation was observed among women and non‐White patients. These findings suggest that covering home‐based CR could improve participation among Medicare beneficiaries.

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