Geographic Variation in Cardiac Rehabilitation Access

Details

• Alternative Title:
  J Am Coll Cardiol
• Personal Author:
  Duncan, Meredith S. ; Robbins, Natalie N. ; Wernke, Steven A. ; Greevy, Robert A. ; Jackson, Sandra L. ; Beatty, Alexis L. ; Thomas, Randal J. ; Whooley, Mary A. ; Freiberg, Matthew S. ; Bachmann, Justin M.
• Description:
  Background:
  
  There is marked geographic variation in cardiac rehabilitation (CR) initiation, ranging from 10-40% of eligible patients at the state level. The potential causes of this variation, such as patient access to CR centers, are not well studied.
  
  Objectives:
  
  The authors sought to determine how access to CR centers affects CR initiation in Medicare beneficiaries.
  
  Methods:
  
  The authors used Medicare files to identify CR-eligible Medicare beneficiaries and calculate CR initiation rates at the hospital referral region (HRR) level. We used linear regression to evaluate the percent variation in CR initiation accounted for by CR access across HRRs. We then employed geospatial hotspot analysis to identify CR deserts, or counties in which patient load per CR center is disproportionately high.
  
  Results:
  
  A total of 1,269,147 Medicare beneficiaries were eligible for CR from 2014 to 2017, of whom 314,997 (25%) initiated CR. The West North Central Census Division had the highest adjusted CR initiation rate (37.0%) and the highest density of CR programs (5.89 per 1,000 CR-eligible Medicare beneficiaries). Density of CR programs accounted for 23.5% of geographic variation in CR initiation at the HRR level. A total of 39 largely urban counties comprising 13% of the United States population age ≥65 had disproportionately low CR access and were identified as CR deserts.
  
  Conclusions:
  
  A substantial proportion of geographic variation in CR initiation was related to access to CR programs, with a significant amount of the U.S. population living in CR deserts. These data invite further study on interventions to increase CR access.
  
  
• Subjects:
  Aged Cardiac Rehabilitation Humans Medicare United States
• Keywords:
  Access To Care Cardiac Rehabilitation Geographic Variation
• Source:
  J Am Coll Cardiol. 81(11):1049-1060
• Pubmed ID:
  36922091
• Pubmed Central ID:
  PMC10901160
• Document Type:
  Journal Article
• Funding:
  UL1 TR000445/TR/NCATS NIH HHSUnited States/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; IK2 HX003021/HX/HSRD VAUnited States/ ; K12 HS022990/HS/AHRQ HHSUnited States/ ; KL2 TR001996/TR/NCATS NIH HHSUnited States/
• Volume:
  81
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:fc27b6c5950eff4a62a8a17e267275b5e6d5200271f6c701d0d2a1492c7f00aa
• Download URL:
  https://stacks.cdc.gov/view/cdc/150371/cdc_150371_DS1.pdf
• File Type:
  [PDF - 858.88 KB ]