Trends in Cardiac Rehabilitation Participation Among Veterans and Medicare Beneficiaries With Stable Heart Failure, 2012 to 2022

BACKGROUND: Heart failure (HF) affects 6.7 million American adults and is associated with significant morbidity and mortality. Cardiac rehabilitation (CR) is a behavior modification program recommended to improve health outcomes in patients with HF. In 2014, Medicare began covering facility-based CR for patients with stable HF, and some Veterans Affairs (VA) facilities began offering home-based CR. METHODS: ) codes. CR participation was determined using Current Procedural Terminology codes and VA stop codes during the 12 months following HF diagnosis. A multivariable logistic regression was constructed to identify patient characteristics associated with participation. RESULTS: From 2012 to 2022, VA participation increased from 7.4% to 10.4% and Medicare decreased from 7.4% to 5.1%. From 2016 to 2022, 13.2% of veterans and 6.7% of Medicare beneficiaries with stable HF participated in CR. Older age, female sex, and non-White race were associated with lower participation, and comorbid ischemic heart disease was associated with greater participation (odds ratio [OR], 1.48 [95% CI, 1.45-1.52] in VA; OR, 2.69 [95% CI, (2.62-2.78] in Medicare). CONCLUSIONS: Following the VA's implementation of home-based CR and Medicare's facility-based CR coverage for stable HF, participation increased among veterans but not among Medicare beneficiaries. Lower participation was observed among women and non-White patients. These findings suggest that covering home-based CR could improve participation among Medicare beneficiaries.