Predictors Of Participation in Cardiac Rehabilitation
Despite the numerous health benefits of cardiac rehabilitation, participation is extremely low; just 20% of eligible patients enroll in a cardiac rehab program. This brings up an obvious question: WHY? In this article we seek to provide some insight into the main reasons for low participation in cardiac rehabilitation. Below you’ll find the most powerful predictors of cardiac rehab participation based on the literature (keep in mind that this list is not exhaustive).
1. The strength of the primary physician’s recommendation for participation.
The greatest predictor of cardiac rehab participation is the strength of the physician’s recommendation. Patients rely on guidance from their physicians, especially since CR is just one bit of information that they’re receiving after discharge. Early referral to CR is important as well. For every day that a person waits to start CR, that person is 1% less likely to enroll.
2. Minority status.
Women, minorities, older people, and those with other medical conditions are under-referred to cardiac rehab. Black women are 60% less likely than white women to be referred and enroll in cardiac rehab programs. One of the best predictors of cardiac rehab referral is whether the eligible person speaks English.
3. Commute time.
CR participation is lower in rural areas; people who live outside of metropolitan areas are 30% less likely to participate in cardiac rehab programs. There are only enough CR clinics in the U.S. to handle 48% of the eligible population so there is a clear shortage of CR providers. This is especially problematic for patients living in rural areas where they may live hours away from the nearest program.
Socioeconomic status is a driver of CR participation. People who make more than $75,000 per year are twice as likely to participate as individuals with annual incomes below $15,000. A typical insurance co-pay per session of CR is around $20 though some co-pays can reach $60 per session! Over the course of 36 sessions, the cost of CR can add up to hundreds or even thousands of dollars in co-pays alone (not taking into account other costs such as travel or missed work).
What can be done?
First of all, obtaining an early and strong recommendation from a physician, as well as working hard to get patients started as quickly as possible, is an important strategy to increase CR participation. It is also imperative that we as a CR industry expand access to CR to women and minorities. Automatic and systematic referral processes can offer a starting point for referral initiatives by simplifying the process of connecting all eligible patients with CR programs.
Secondly, expanding access to care through virtual or home-based programs is an effective strategy for improving participation. Allowing patients to complete sessions remotely reduces barriers such as commute time, work conflicts, and cost. Furthermore, using digital tools for home-based CR allows for technical improvements such as automatic referral and multi-language support.