{
  "release_id": "73130c34862e2d06",
  "id": "cardio:bottleneck-low-cardiac-rehab-participation",
  "owner": "cardio",
  "kind": "bottleneck",
  "slug": "bottleneck-low-cardiac-rehab-participation",
  "name": "Low participation in cardiac rehabilitation among eligible patients",
  "aliases": [],
  "atlases": [
    "cardio"
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  "summary_plain": "Only about 1 in 4 people who were eligible for cardiac rehabilitation under Medicare in 2016 attended any sessions. In a study of Medicare fee-for-service beneficiaries, 24.4% took part, fewer took part among women, Hispanic and non-Hispanic Black beneficiaries and in some regions, and about a quarter of those who took part completed the program. The Million Hearts road map set a goal of at least 70% participation by 2022. A joint scientific statement from rehabilitation and cardiology societies also describes the use of cardiac rehabilitation in the United States as significantly underused.",
  "summary_technical": "The burden claim rests on one observational claims study of Medicare fee-for-service beneficiaries eligible in 2016 and followed through 2017 (Circulation: Cardiovascular Quality and Outcomes, 2020). It covers one insurance group and one period; this record has not looked for later data, and the 2022 goal date has passed. The Million Hearts cardiac rehabilitation toolkit (second edition, 2023) is aimed at hospital teams that want to raise use; its content is cite-only here. The same joint statement is the source for the home-based programs idea.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-15",
  "last_evidence_check": "2026-10-15",
  "next_review_due": null,
  "identifiers": [],
  "navigation": {
    "cardio": {
      "system": [
        "heart"
      ],
      "condition-area": [
        "acute-care-and-long-term-living"
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    }
  },
  "payload": {
    "stage": "After a qualifying heart event or procedure, when eligible people are referred, enroll, start and complete the program",
    "scope": "In the study: United States Medicare fee-for-service beneficiaries who were eligible for cardiac rehabilitation in 2016. The scientific statement speaks of eligible patients in the United States generally.",
    "severity_rationale": "In the study, 24.4% of eligible beneficiaries participated and the authors note marked disparities; the abstract calls this 1 in 4.",
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    "current_efforts": [
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      "category": "burden",
      "statement": "In an observational study of Medicare fee-for-service beneficiaries who were eligible for cardiac rehabilitation in 2016, 89,327 of 366,103 (24.4%) participated (attended at least 1 session), assessed through 2017. Of those who participated, 24.3% started within 21 days of the qualifying event and 26.9% completed rehabilitation (36 or more sessions attended). Participation was lower among women (18.9%) than men (28.6%), and lower among Hispanic (13.2%) and non-Hispanic Black (13.6%) beneficiaries than non-Hispanic white beneficiaries (25.8%). It varied by region, from 18.6% (East South Central Census Division) to 39.1% (West North Central), and by qualifying event, from 7.1% (acute myocardial infarction without procedure) to 55.3% (coronary artery bypass surgery only). The Million Hearts Cardiac Rehabilitation Collaborative set a road map goal of raising participation rates to 70% or more by 2022.",
      "context": {
        "id": "cardio:ctx-medicare-cr-eligible-2016",
        "label": "Medicare fee-for-service beneficiaries eligible for cardiac rehabilitation in 2016",
        "recipient": "adult",
        "population": "Medicare fee-for-service beneficiaries who were eligible for cardiac rehabilitation in 2016 (366,103 people), identified through a qualifying event: acute myocardial infarction hospitalization, coronary artery bypass surgery, heart valve repair or replacement, percutaneous coronary intervention, or heart or heart-lung transplant.",
        "care_setting": "Medicare fee-for-service claims in the United States.",
        "geography": "United States; results are also given by Census Division and hospital referral region.",
        "life_stage_note": "Adults; participation decreased with increasing age (abstract). The abstract gives no age range.",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
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        "postnatal_age_status": null,
        "followup_description": "Participation, timely initiation and completion were assessed through 2017.",
        "eligibility": {
          "inclusion": [
            "Medicare fee-for-service beneficiaries who were eligible for cardiac rehabilitation in 2016"
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          "exclusion": []
        }
      },
      "evidence_stage": "observational",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "Medicare fee-for-service beneficiaries only, so the figures do not describe people with other coverage. Participation means attending at least one session. The study is observational and uses claims, and the abstract gives no reasons for non-participation. It covers a 2016 eligible group followed through 2017; this record has not looked for later data, and the 2022 goal date has passed. The AACVPR, AHA and ACC scientific statement separately describes the use of cardiac rehabilitation in the United States as significantly underused.",
      "editorial_state": "draft",
      "checked_at": "2026-10-15",
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