Abstract 13706: Expanded Coverage for Cardiac Rehabilitation in Heart Failure Patients Accelerated Annual Rates of Use

Introduction: Cardiac rehabilitation (CR) reduces morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). In an effort to improve enrollment, Medicare expanded coverage for CR to include HFrEF patients in 2014, but the impact of this policy change is unknown. Methods: A 20% sample of Medicare inpatient, outpatient, and carrier claim files (2008 to 2017) were used to identify 849,054 patients with HFrEF, defined as having ≥ 2 outpatient claims or ≥ 1 inpatient hospitalization for chronic systolic heart failure during a calendar year. Patients who died within the calendar year of diagnosis were excluded. CR participation was identified using CPT and revenue center codes. We performed an interrupted time-series analysis to estimate annual rates of CR use over the ten year period, annual changes in CR use in the pre- (2008-2013) and post-policy (2014-2017), and the differences in annual trends pre- vs. post-policy. Results were risk adjusted by age, sex, race, dual eligibility, and Charlson comorbidities. Results: A total of 34,179 (4.0%) beneficiaries with HFrEF attended CR during the study period. Annual trends in CR enrollment are shown in Figure 1 . From 2008 to 2014, CR utilization increased from 3.30% to 4.30% at an annual absolute change of 0.15% per year (p<0.001). After Medicare expanded coverage, rates of CR enrollment went from 4.30% in 2014 to 5.54% in 2017, at an annual absolute change of 0.31% (p<0.001). Comparing trends in participation before and after the change in policy, the annual rate of change in CR enrollment was 0.16% higher on an absolute scale (p<0.001). Conclusions: Although the absolute enrollment rate of patients with HFrEF in CR remains low, expanding coverage in 2014 was associated with a doubling in the annual rate of increase of CR use. Interventions beyond coverage changes, at the individual, provider, and system level, are needed to improve CR participation in HFrEF patients.