The Relationship Between Discharge Location and Cardiac Rehabilitation Use After Cardiac Surgery

Background Cardiac rehabilitation (CR) is a guideline-recommended risk reduction program offered to cardiac surgical patients. Despite CR’s association with better outcomes, attendance remains poor. The relationship between discharge location and CR use is poorly understood. Methods This study was a nationwide, retrospective cohort analysis of Medicare fee-for-service claims for beneficiaries undergoing coronary artery bypass grafting and/or surgical aortic valve repair between 07/01/2016 and 12/31/2018. The primary outcome was attendance of any CR session. Discharge location was categorized as home discharge or discharge to extended care facility (ECF) [including skilled nursing facility (SNF), inpatient rehabilitation (IPR), and long-term acute care (LTAC)]. Multivariable logistic regression models evaluated the association between discharge location, CR attendance and one-year mortality. Results Of the 167,966 patients who met inclusion criteria, 34.1% discharged to an ECF. Overall CR usage rate was 53.9%. Unadjusted and adjusted CR usage was lower among patients discharged ECFs versus those discharged home (42.1% vs 60.0%; ORadj: 0.67; p<0.001). Patients discharged to LTAC were less likely to use CR than those discharged to SNF or IPR (ref: home, ORadj LTAC=0.34, ORad SNF=0.67, ORad IPR=0.71, p<0.001). CR attendance was associated with a greater reduction in adjusted one-year mortality in patients discharged to ECFs (9.7% reduction) vs those discharged home (4.3% reduction). Conclusions In this national analysis of Medicare beneficiaries, discharge to ECF was associated with lower CR use, despite a greater association with improved 1-year mortality. Interventions aimed at increasing CR enrollment at ECFs may improve CR use and advance surgical quality.