医疗保险受益人心力衰竭患者参与心脏康复治疗的时间趋势及相关因素。
Temporal Trends and Factors Associated With Cardiac Rehabilitation Participation Among Medicare Beneficiaries With Heart Failure.
机构信息
Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA.
出版信息
JACC Heart Fail. 2021 Jul;9(7):471-481. doi: 10.1016/j.jchf.2021.02.006. Epub 2021 May 12.
OBJECTIVES
The purpose of this study was to assess temporal trends and factors associated with cardiac rehabilitation (CR) enrollment and participation among Medicare beneficiaries after the 2014 Medicare coverage expansion.
BACKGROUND
CR improves exercise capacity, quality of life, and clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). In 2014, Medicare coverage for CR was expanded to include chronic HFrEF.
METHODS
Among Medicare beneficiaries from quarter (Q) 1 2014 to Q2 2016, 11,696 patients from 14,258 hospitalizations with primary discharge diagnosis of HF were identified. Patients with HF with preserved ejection fraction were excluded. Quarterly CR participation rates among hospitalized HF patients within 6 months of discharge were identified through outpatient administrative claims. The predictors of CR participation were assessed with the use of a multivariable logistic regression model that included patient- and hospital-level characteristics. A secondary analysis to assess participation rates of CR after outpatient encounters for HF was performed.
RESULTS
Overall, only 611 (4.3%) and 349 (2.2%) eligible patients participated CR after primary hospitalization or outpatient visit for HF, respectively. There was a modest, statistically significant increase in CR participation after HF admissions (2.8% in Q1 2014; 5.0% in Q2 2016; p < 0.001) without significant increase after outpatient visits for HF (2.6% to 3.8%; p = 0.21). Younger age, male sex, nonblack race, previous cardiovascular procedures, and hospitalization at hospitals with available CR facilities were all independently associated with CR participation.
CONCLUSIONS
CR participation among eligible Medicare beneficiaries with HFrEF was low with minimal increase since 2014 Medicare coverage decision. Sex, race, and institution-dependent variables were independent predictors of CR participation.
目的
本研究旨在评估在 2014 年 Medicare 覆盖范围扩大后，医疗保险受益人群接受和参与心脏康复（CR）的时间趋势和相关因素。
背景
CR 可提高射血分数降低的心力衰竭（HFrEF）患者的运动能力、生活质量和临床结局。2014 年，医疗保险对 CR 的覆盖范围扩大到包括慢性 HFrEF。
方法
在 2014 年第 1 季度至 2016 年第 2 季度期间，从 14258 例因 HF 初次出院诊断的住院患者中，共识别出 11696 例患者。排除射血分数保留的 HF 患者。通过门诊行政索赔确定在出院后 6 个月内住院 HF 患者的季度 CR 参与率。使用包括患者和医院水平特征的多变量逻辑回归模型评估 CR 参与的预测因素。还进行了一项次要分析，以评估门诊 HF 就诊后 CR 的参与率。
结果
总体而言，仅有 611 名（4.3%）和 349 名（2.2%）符合条件的患者在初次住院或门诊 HF 就诊后接受了 CR，分别。HF 入院后 CR 参与率略有显著增加（2014 年第 1 季度为 2.8%；2016 年第 2 季度为 5.0%；p<0.001），但 HF 门诊就诊后没有显著增加（从 2.6%增至 3.8%；p=0.21）。年龄较小、男性、非黑人种族、既往心血管操作以及在有 CR 设施的医院住院，均与 CR 参与独立相关。
结论
在符合条件的 Medicare 受益人群中，HFrEF 患者的 CR 参与率较低，自 2014 年 Medicare 覆盖范围决策以来，参与率仅略有增加。性别、种族和机构相关变量是 CR 参与的独立预测因素。
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