Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX (N.K., V.S., A.P.).
Parkland Health and Hospital System, Dallas, TX (N.K., V.S., A.P.).
Circ Heart Fail. 2023 Aug;16(8):e010144. doi: 10.1161/CIRCHEARTFAILURE.122.010144. Epub 2023 Jul 11.
Coverage 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.
Patients 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.
Of 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 (<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]; =0.049) without significant differences in 1-year readmission.
CR 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.
2014 年，心脏康复（CR）的覆盖范围扩大到射血分数降低的心力衰竭患者，但目前仍不清楚其转诊和参与率。
从 2010 年至 2020 年，纳入美国心脏协会 Get With The Guidelines-Heart Failure 注册研究中因射血分数降低（≤35%）而住院的心力衰竭患者，描述 CR 转诊情况为是、否或未记录。在总体队列中评估 CR 转诊的时间趋势。使用多变量调整的逻辑回归模型评估患者和医院水平的 CR 转诊预测因素。此外，在有可用医疗保险行政索赔数据的年龄 >65 岁且出院后 6 周内临床稳定的患者中，评估了在 1 年内转诊后接受 CR 治疗和在 1 年内接受 CR 治疗的比例。最后，使用多变量调整的 Cox 模型评估 CR 转诊与 1 年死亡和再入院风险的关系。
在 69441 名有资格接受 CR（中位年龄 67 岁；33%为女性；30%为黑人）的射血分数降低的心力衰竭患者中，有 17076 名（24.6%）被转诊至 CR，转诊率从 2010 年的 8.1%增加到 2020 年的 24.1%（<0.001）。在 8310 名出院后 6 周内临床稳定的 Medicare 患者中，CR 转诊率为 25.8%，转诊患者中 CR 的使用率为 4.1%（平均就诊次数：6.7 次）。未转诊的患者更可能年龄较大，为黑人，合并症负担更重。在调整分析中，与未转诊的患者相比，有资格接受 CR 的射血分数降低的心力衰竭患者的 1 年死亡风险较低（风险比，0.84 [95%CI，0.70-1.00]；=0.049），1 年再入院率无显著差异。
从 2010 年到 2020 年，CR 的转诊率有所增加。然而，只有 1/4 的患者被转诊到 CR。在接受 CR 转诊的合格患者中，参与率较低，只有不到 1/20 的患者接受了 CR 治疗。
