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AHA Advisory Identifies Obstacles, Solutions to Low Cardiac Rehab Use

By Robert Fay

Several care delivery models contained in the Patient Protection and Affordable Care Act (ACA) could enhance the quality of and access to cardiac rehabilitation programs, according to an American Heart Association scientific advisory published on November 14, 2011 on the Circulation website.

Cardiac rehabilitation/secondary prevention programs (CR/SPPs) are medically supervised programs that help patients with cardiovascular disease recover more quickly after a cardiac event or procedure. Multifaceted programs that include nutritional counseling, aggressive risk factor management (such as lipids, hypertension, weight, tobacco use, and diabetes), psychosocial and vocational counseling, and exercise training, CR/SPPs have been shown to improve coronary heart disease risk factors and exercise capacity, and a range of recent guidelines have included a Class I-level recommendation for referral to CR/SSPs. The statement authors characterize the use of such programs as "dismally low," however; between 14 percent and 35 percent of heart attack survivors and approximately 30 percent of coronary artery bypass graft surgery patients participate in CR/SPPs. Participation is especially low among women, minorities, and the elderly. With this in mind, the authors developed the statement to identify barriers to participation and to develop new models of delivery.

Barriers to CR/SPP participation include lack of insurance coverage, inability to afford co-payments, low health literacy, language, transportation, and multiple comorbidities. Healthcare factors that may play a part include lack of referral, limited facilitation of enrollment after referral, and program availability and characteristics. The statement emphasizes the ACA, the implementation of which will provide opportunities to expand access to CR/SPPs, which supports several new healthcare delivery models such as accountable care organizations, patient-centered medical homes, wellness initiatives, care coordination for those eligible for both Medicare and Medicaid, and delivery system models tested through the Center for Medicare and Medicaid Innovation, such as home-based and Internet-based models. In addition, the essential benefits package, which is scheduled for implementation in 2014, includes a rehabilitative and habilitative services and devices category, which should greatly increase access to CR/SPPs.

Source: Balady GJ, Ades PA, Bittner VA, et al. 2011. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Published on November 14, 2011 on the Circulation website.