Greater frailty associated with greater mortality benefit from postop cardiac rehab
Medicare beneficiaries with a higher score on a frailty index were less likely to participate in cardiac rehabilitation after percutaneous or surgical revascularization or aortic valve replacement, although rehab was associated with improved survival.
Frail patients who undergo cardiovascular procedures are less likely to participate in cardiac rehabilitation after cardiac surgery than those who are not frail, even though they could see more benefit, according to a recent study.
The retrospective analysis used Medicare fee-for-service claims to identify more than 500,000 patients who underwent percutaneous or surgical revascularization or aortic valve replacement in July 2016 to December 2018 and survived at least 30 days after discharge. Their average age was 75.9 years, and 37.0% were women. Results of this analysis of their use of cardiac rehabilitation were published by Circulation: Cardiovascular Quality & Outcomes on Nov. 21.
When patients were stratified into quartiles based on the claims-based frailty index, the study found that their rate of attending at least one rehab session declined with increasing frailty (49.7% for quartile 1, 42.2% for quartile 2, 35.3% for quartile 3, and 23.7% for quartile 4; adjusted odds ratio for quartile 1 vs. 4, 0.63 [95% CI, 0.62 to 0.64]). Increasing frailty was also associated with higher one-year mortality risk (2.5%, 5.1%, 9.0%, and 16.9% for the four respective quartiles), and one-year mortality was associated with cardiac rehab use: Rates were 11.9% in nonparticipants versus 2.6% in participants (P<0.001). The reduction in mortality associated with rehab participation was greater among frailer patients, with a 2.7% difference between participants and nonparticipants in quartile 1 compared to a 14.3% difference between groups in quartile 4 (P<0.001).
“This study, combined with the existing literature, suggests that frail patients do, in fact, stand to benefit more than nonfrail patients from CR [cardiac rehabilitation] attendance, and CR is underutilized in this group,” the study authors said. One challenge, they noted, is that the current supply of rehab may not be enough to meet the needs of all eligible patients. “While efforts to expand outpatient CR programs to provide slots for all eligible patients should be continued, this study argues that frail patients are a subgroup that should be prioritized for CR referrals and enrollment,” they concluded.
Limitations of the study include that it only looked at Medicare fee-for-service beneficiaries and did not determine whether patients who did not attend rehab had been referred to it or not.