Husaini Mustafa, Deych Elena, Racette Susan B, Rich Michael W, Joynt Maddox Karen E, Peterson Linda R
Division of Cardiovascular Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri (Drs Husaini, Racette, Rich, Joynt Maddox, and Peterson and Ms Deych); and Program in Physical Therapy, Washington University School of Medicine, Saint Louis, Missouri (Dr Racette).
J Cardiopulm Rehabil Prev. 2022 May 1;42(3):156-162. doi: 10.1097/HCR.0000000000000632. Epub 2021 Sep 9.
Intensive cardiac rehabilitation (ICR) was developed to enhance traditional cardiac rehabilitation (CR) by adding sessions focused on nutrition, lifestyle behaviors, and stress management. Intensive CR has been Medicare-approved since 2010, yet little is known about national utilization rates of ICR in the Medicare population or characteristics associated with its use.
A 5% sample of Medicare claims data from 2012 to 2016 was used to identify beneficiaries with a qualifying indication for ICR/CR and to quantify utilization of ICR or CR within 1 yr of the qualifying diagnosis.
From 2012 to 2015, there were 107 246 patients with a qualifying indication. Overall, only 0.1% of qualifying patients participated in ICR and 16.2% in CR from 2012 to 2016, though utilization rates of both ICR and CR increased during this period (ICR 0.06 to 0.17%, CR 14.3 to 18.2%). The number of ICR centers increased from 15 to 50 over the same period. There were no differences between ICR and CR enrollees with respect to age, sex, race, discharge location, median income, dual enrollment, or number of comorbidities. Compared with eligible beneficiaries who did not attend ICR or CR, those who attended either program were younger, more likely to be male and White, and had higher median income.
Although ICR and CR have a class 1 indication for the treatment of cardiovascular disease and the number of ICR centers has increased, ICR is not widely available and remains markedly underutilized. Continued research is needed to understand the barriers to program development and patient participation.
强化心脏康复（ICR）通过增加关注营养、生活方式行为和压力管理的环节来强化传统心脏康复（CR）。自2010年以来，强化CR已获医疗保险批准，但对于医疗保险人群中ICR的全国利用率或其使用相关特征知之甚少。
使用2012年至2016年医疗保险理赔数据的5%样本，以识别有ICR/CR合格指征的受益人，并量化合格诊断后1年内ICR或CR的利用率。
2012年至2015年，有107246名患者有合格指征。总体而言，2012年至2016年，仅有0.1%的合格患者参加了ICR，16.2%的患者参加了CR，不过在此期间ICR和CR的利用率均有所提高（ICR从0.06%升至0.17%，CR从14.3%升至18.2%）。同期ICR中心的数量从15个增加到了50个。ICR和CR参与者在年龄、性别、种族、出院地点、收入中位数、双重参保或合并症数量方面没有差异。与未参加ICR或CR的合格受益人相比，参加这两种项目的人更年轻，更可能是男性和白人，且收入中位数更高。
尽管ICR和CR对心血管疾病治疗有1类指征且ICR中心数量有所增加，但ICR并未广泛普及，利用率仍然明显偏低。需要持续开展研究以了解项目发展和患者参与的障碍。
