Cardiac Rehabilitation Remains Low for Eligible Medicare Beneficiaries


But expanding coverage in 2014 was associated with a notable increase in enrollment among individuals with heart failure, study results show.

Cardiac rehabilitation enrollment rose among individuals with heart failure (HF) with reduced ejection fraction (EF) after Medicare started covering it in 2014, but overall enrollment among Medicare beneficiaries remains less than 10% of those eligible, according to preliminary research results.

“Despite clear benefits of cardiac rehabilitation in preventing death, reducing hospitalizations, and improving physical ability, cardiac rehabilitation is used by very few. Based on the current data, more than 90% of people with heart failure will not receive a treatment that could improve their health and survival,” Vinay Guduguntla, MD, internal medicine resident at the University of California, said in a statement.

Prior to 2014, fewer than 3% of eligible individuals had enrolled in cardiac rehabilitation.

Investigators analyzed a sample of Medicare claims data from 2008 to 2017 prior to and after the 2014 ruling. They included 849,054 Medicare fee-for-service beneficiaries, aged 65 years or older, who had HF with reduced EF.

Of the individuals, nearly 34,200, or about 4%, attended cardiac rehabilitation during the study period.

From 2008 to 2014, cardiac rehabilitation use increased slowly to 4.30% from 3.30%, about a 5% relative increase year over year, investigators said.

Although the absolute enrollment rate in cardiac rehabilitation remained low, expanding Medicare coverage in 2014 was associated with a notable increase in the use of cardiac rehabilitation among individuals with HF.

“Our study highlights insurance coverage as 1 important factor that impacts increasing cardiac rehabilitation participation. Future work should aim to identify and address all barriers to enrollment and find creative solutions to this complex problem,” Guduguntla said.

Investigators noted that the Centers for Medicare and Medicaid Services criteria require individuals to wait at least 6 weeks after a HF hospitalization to participate, which they call a significant barrier.

A limitation of the study is the lack of information about cardiac rehabilitation by location, race/ethnicity, and other demographic factors about individuals.

The findings will be presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2021 on November 15, 2021.


Less than 10% of adults with heart failure get cardiac rehab despite Medicare expansion. EurekAlert. News release. November 8, 2021. Accessed November 9, 2021.

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