Patterns of Referral and Postdischarge Utilization of Cardiac Rehabilitation Among Patients Hospitalized With Heart Failure: An Analysis From the GWTG-HF Registry.
| dc.contributor.author | Keshvani, Neil | |
| dc.contributor.author | Subramanian, Vinayak | |
| dc.contributor.author | Wrobel, Christopher A | |
| dc.contributor.author | Solomon, Nicole | |
| dc.contributor.author | Alhanti, Brooke | |
| dc.contributor.author | Greene, Stephen J | |
| dc.contributor.author | DeVore, Adam D | |
| dc.contributor.author | Yancy, Clyde W | |
| dc.contributor.author | Allen, Larry A | |
| dc.contributor.author | Fonarow, Gregg C | |
| dc.contributor.author | Pandey, Ambarish | |
| dc.date.accessioned | 2024-06-06T14:52:38Z | |
| dc.date.available | 2024-06-06T14:52:38Z | |
| dc.date.issued | 2023-08 | |
| dc.description.abstract | BackgroundCoverage for cardiac rehabilitation (CR) for patients with heart failure with reduced ejection fraction was expanded in 2014, but contemporary referral and participation rates remain unknown.MethodsPatients hospitalized for heart failure with reduced ejection fraction (≤35%) in the American Heart Association Get With The Guidelines-Heart Failure registry from 2010 to 2020 were included, and CR referral status was described as yes, no, or not captured. Temporal trends in CR referral were assessed in the overall cohort. Patient and hospital-level predictors of CR referral were assessed using multivariable-adjusted logistic regression models. Additionally, CR referral and proportional utilization of CR within 1-year of referral were evaluated among patients aged >65 years with available Medicare administrative claims data who were clinically stable for 6-weeks postdischarge. Finally, the association of CR referral with the risk of 1-year death and readmission was evaluated using multivariable-adjusted Cox models.ResultsOf 69,441 patients with heart failure with reduced ejection fraction who were eligible for CR (median age 67 years; 33% women; 30% Black), 17,076 (24.6%) were referred to CR, and referral rates increased from 8.1% in 2010 to 24.1% in 2020 (Ptrend<0.001). Of 8310 patients with Medicare who remained clinically stable 6-weeks after discharge, the CR referral rate was 25.8%, and utilization of CR among referred patients was 4.1% (mean sessions attended: 6.7). Patients not referred were more likely to be older, of Black race, and with a higher burden of comorbidities. In adjusted analysis, eligible patients with heart failure with reduced ejection fraction who were referred to CR (versus not referred) had a lower risk of 1-year death (hazard ratio, 0.84 [95% CI, 0.70-1.00]; P=0.049) without significant differences in 1-year readmission.ConclusionsCR referral rates have increased from 2010 to 2020. However, only 1 in 4 patients are referred to CR. Among eligible patients who received CR referral, participation was low, with <1 of 20 participating in CR. | |
| dc.identifier.issn | 1941-3289 | |
| dc.identifier.issn | 1941-3297 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Ovid Technologies (Wolters Kluwer Health) | |
| dc.relation.ispartof | Circulation. Heart failure | |
| dc.relation.isversionof | 10.1161/circheartfailure.122.010144 | |
| dc.rights.uri | ||
| dc.subject | Humans | |
| dc.subject | Aftercare | |
| dc.subject | Patient Discharge | |
| dc.subject | Registries | |
| dc.subject | Aged | |
| dc.subject | Medicare | |
| dc.subject | Referral and Consultation | |
| dc.subject | United States | |
| dc.subject | Female | |
| dc.subject | Male | |
| dc.subject | Heart Failure | |
| dc.subject | Cardiac Rehabilitation | |
| dc.title | Patterns of Referral and Postdischarge Utilization of Cardiac Rehabilitation Among Patients Hospitalized With Heart Failure: An Analysis From the GWTG-HF Registry. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Solomon, Nicole|0000-0002-5643-9958 | |
| duke.contributor.orcid | Alhanti, Brooke|0000-0003-4243-8062 | |
| duke.contributor.orcid | Greene, Stephen J|0000-0001-6912-7374 | |
| duke.contributor.orcid | DeVore, Adam D|0000-0002-4679-2221 | |
| pubs.begin-page | e010144 | |
| pubs.issue | 8 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Staff | |
| pubs.organisational-group | Basic Science Departments | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Biostatistics & Bioinformatics | |
| pubs.organisational-group | Medicine | |
| pubs.organisational-group | Medicine, Cardiology | |
| pubs.organisational-group | Duke Clinical Research Institute | |
| pubs.publication-status | Published | |
| pubs.volume | 16 |
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