title: Participation in Cardiac Rehabilitation Among Patients With Heart Failure.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) is linked to reduced mortality and morbidity, including improvements in cardiorespiratory fitness, psychosocial state, and quality of life in patients with heart failure (HF). However, little is known about CR utilization among patients with HF.
  
  
  OBJECTIVE
  We sought to determine (a) the proportion of patients with HF who participated in CR and (b) patient characteristics associated with participation.
  
  
  METHODS
  A retrospective study was conducted with the use of national data from the Centers for Medicare and Medicaid Services and the Veterans Health Administration. We used primary discharge ICD-9 codes to identify patients hospitalized for HF during 2007-2011 and identified CR participation with the use of current procedure terminology codes from claims data. Multivariate logistic regression was used to identify patient characteristics associated with CR participation.
  
  
  RESULTS
  There were 66,710 veterans and 243,208 Medicare beneficiaries hospitalized for HF and 1554 (2.3%) and 6280 (2.6%), respectively, who attended ≥1 sessions of outpatient CR. Among Medicare beneficiaries, men were more likely than women to participate in CR (3.7% vs 1.8%; P < .001), but there was no gender difference among veterans (2.3% vs 2.8%; P = .40). Characteristics associated with participation in CR in both groups included younger age, white race, and history of ischemic heart disease.
  
  
  CONCLUSIONS
  Very few HF patients participated in CR, with lower rates among older non-white women with a history of depression or other chronic medical conditions. Because Medicare has recently introduced coverage for CR in patients with systolic HF, we must increase efforts to improve CR participation, especially among these vulnerable groups.
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California; School of Nursing, Department of Community Health Systems, University of California, San Francisco, California. Electronic address: linda.park@ucsf.edu.
authors.forename: Linda G
authors.initials: LG
authors.lastname: Park
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, General Internal Medicine, University of California, San Francisco, California.
authors.forename: David W
authors.initials: DW
authors.lastname: Schopfer
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, General Internal Medicine, University of California, San Francisco, California; Department of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, California.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000072038:Cardiac Rehabilitation / Q000379:methods / Q000639:trends*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D006278:Medicare / Q000639:trends; D010358:Patient Participation; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends
keywords: cardiovascular disease; exercise; medicare; veterans