June 2013

Team discusses value of cardiac rehab for heart failure patients

Earlier this year, a multi-organizational team of healthcare professionals met with representatives from the Centers for Medicare & Medicaid Services (CMS) to discuss the value of cardiac rehabilitation for heart failure (HF) patients. Anne Gavic-Ott, Manager of Cardiopulmonary Rehabilitation at NCH, participated in the meeting in her role as president of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).

Heart Failure is the No. 1 hospital discharge diagnosis for patients over 65, accounting for more than 1 million hospitalizations and close to $40 billion in healthcare costs per year. On average, 25 percent of these patients are readmitted to the hospital within 30 days following discharge, adding to the significant financial and human burden attributed to heart failure.

Cardiac Rehabilitation (CR) is a multifaceted program of exercise training, education and counseling designed to improve a patient's functional capacity and quality of life, improve healthy behaviors, decrease risk for future cardiac events and improve patient self-management skills. Currently, patients eligible for CR under the Medicare rules include those who have experienced a myocardial infarction, percutaneous coronary intervention, coronary bypass surgery, valve replacement or repair, heart transplant, or those currently experiencing chronic stable angina. A glaring omission on this list is the heart failure patient who stands to gain significant benefit from CR participation.

Considerable evidence supports the benefit of exercise training for HF patients, including improved functional capacity, reduced symptoms and decreased mortality and hospitalizations. Additional evidence has shown that education and counseling designed to improve patient self-management skills can reduce re-hospitalizations and improve health-related quality of life. Since cardiac rehabilitation includes both exercise training and education and counseling, there is potential for critical benefits in HF patients participating in CR.

In order to share this research in an organized manner, a writing team created by AACVPR developed a white paper reviewing compelling evidence related to benefits of exercise training and cardiac rehabilitation services for HF patients. On February 28, representatives from AACVPR, the American College of Cardiology (ACC), the American Hospital Association (AHA) and the Heart Failure Society of America (HFSA) met with representatives from CMS to discuss these benefits. The goal was to explore the feasibility of a formal request to include selected HF patients as eligible for CR Medicare benefits. This is one step in a long process, with no guarantee of the outcome at this early date. However with CMS focused more and more on evidence-based patient outcomes and cost reduction, the hope is that careful consideration will be given to the strength of evidence supporting CR for HF patients.

For more information, contact Anne Gavic-Ott at 847.618.7914.