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Low participation in cardiac rehabilitation among eligible patients

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.

  • Bottleneck
  • In this atlas

Overview

Technical summary

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.

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.

Stage
After a qualifying heart event or procedure, when eligible people are referred, enroll, start and complete the program
Why it is severe
In the study, 24.4% of eligible beneficiaries participated and the authors note marked disparities; the abstract calls this 1 in 4.

Burden

  • Burden Observational Certainty not assessed

    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.

    Applies to Adult
    • 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.
    • Medicare fee-for-service claims in the United States.
    • United States; results are also given by Census Division and hospital referral region.
    • Adults; participation decreased with increasing age (abstract). The abstract gives no age range.
    Follow-up Participation, timely initiation and completion were assessed through 2017.
    Certainty method
    Not assessed
    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.
    Last checked
    2026-10-15
    Next evidence check due
    Not scheduled
    Sources and citations (4)

    1. Supports Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative

      Publication · Circulation. Cardiovascular quality and outcomes · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2020-01-14 · DOI: 10.1161/CIRCOUTCOMES.119.005902 · PMID: 31931615 · PMCID: PMC8091573

      Locator
      Abstract, METHODS AND RESULTS, sentences 1 to 3
      How it applies
      Eligible group, participation, timely initiation and completion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6db5ce7d181853fffb9f652f9ef651232e1df7ddaccaa02faa9ded4505b0516f
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    2. Supports Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative

      Publication · Circulation. Cardiovascular quality and outcomes · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2020-01-14 · DOI: 10.1161/CIRCOUTCOMES.119.005902 · PMID: 31931615 · PMCID: PMC8091573

      Locator
      Abstract, METHODS AND RESULTS, sentence 5
      How it applies
      Differences by sex, ethnicity, region and qualifying event.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6db5ce7d181853fffb9f652f9ef651232e1df7ddaccaa02faa9ded4505b0516f
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    3. Background Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative

      Publication · Circulation. Cardiovascular quality and outcomes · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2020-01-14 · DOI: 10.1161/CIRCOUTCOMES.119.005902 · PMID: 31931615 · PMCID: PMC8091573

      Locator
      Abstract, BACKGROUND, sentence 2
      How it applies
      The 70% participation goal.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6db5ce7d181853fffb9f652f9ef651232e1df7ddaccaa02faa9ded4505b0516f
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    4. Background Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology

      Publication · Circulation · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2019-07-02 · DOI: 10.1161/CIR.0000000000000663 · PMID: 31082266

      Locator
      Abstract, paragraph 1, sentence 2
      How it applies
      Statement that cardiac rehabilitation is significantly underused in the United States.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      826982c6fe78c5bd8a7b612fbd6af9232ad966689235ccf3f9d64e3e36ccc15b
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Current efforts

Record details

Record id
cardio:bottleneck-low-cardiac-rehab-participation
Content hash
1441ef5783fb5670df7c36922eb58e2fed7e29455a3c3b0f2e15dd4e7c29537c