Cardiac rehabilitation participation predicts lower rehospitalization costs

doi:10.1016/0002-8703(92)90696-S

American Heart Journal

Volume 123, Issue 4, Part 1, April 1992, Pages 916-921

https://doi.org/10.1016/0002-8703(92)90696-S Get rights and content

Abstract

The effect of participation in cardiac rehabilitation on medical costs was determined by measuring hospitalization charges for cardiac admissions over a 3-year period in 580 post-coronary event patients (58% after coronary bypass surgery, 42% after myocardial infarction), of whom 230 entered a cardiac rehabilitation program and 350 did not. Baseline left ventricular ejection fraction was similar in entrants and nonentrants (59.9% vs 59.5%). Over the 1 to 46-month follow-up period (mean 21 months), per capita hospitalization charges for participants in cardiac rehabilitation were $739 lower than charges for nonparticipants ($1197 ± 3911 vs $1936 ± 5459, p = 0.022). This was due to both a lower incidence of hospitalizations and lower charges per hospitalization. Inasmuch as groups differed with regard to age, sex, diagnostic category, and smoking status, data were adjusted for these baseline differences by means of analysis of covariance. Rehospitalization charges remained significantly higher in nonparticipants (p = 0.015). Because physician charges were not measured, the cost differential between groups is underestimated. Results of this study show an association between participation in comprehensive cardiac rehabilitation and lowered cardiac rehospitalization costs in the years after an acute coronary event.

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Exercise Counteracts the Cardiotoxicity of Psychosocial Stress
2019, Mayo Clinic Proceedings
Citation Excerpt :
Evidence indicates that this exercise training–induced realignment of blood rheology and the autonomic nervous system could, in part, result from improvements in psychological and behavioral factors.91 Typically, an exercise regimen over time lowers stress, improves functionality, and reduces subsequent rehospitalization costs.93 Exercise training improves many of the systemic derangements associated with depression, including improvements in HR variability, baroreflex reactivity, QT prolongation, autonomic balance, inflammation, hypercoagulability, and endothelial function.94
Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.
Patterns of inpatient care for acute myocardial infarction and 30-day, 3-month and 1-year cardiac diseases readmission rates in Spain
2017, International Journal of Cardiology
Acute myocardial infarction (AMI) is a common cause of hospital discharges and readmissions. Readmissions may indicate poor patient care and avoidable health expenditure, being key in quality improvement strategies. Our aim was to analyse cardiac diseases (CDs) readmissions in patients with AMI in Spain.
A retrospective analysis of 33,538 hospital discharges with AMI being the “principal diagnosis” at hospitals of the Spanish National Health System in 2012 was performed using administrative data. We developed a logistic regression model and calculated 30-day, 3-month and 1-year CDs risk-standardized readmission rates (RSRRs) using a multivariate mixed model.
Variables of the model (AMI location, age, previous angina pectoris/myocardial infarction or acute coronary syndrome, chronic kidney disease, rheumatic valvular disease, diabetes mellitus, vascular disease, female sex, chronic pulmonary disease, and anemia) were able to predict 30-day, 3-month and 1-year readmission rates and RSRRs after AMI (5.4%, 9.3% and 20.2%, respectively). For RSRRs the area under the ROC curve was 0.74 (p = 0.0037), 0.77 (p = 0.0041), and 0.73 (p = 0.0025) for 1, 3 months and 1-year readmission rate, respectively. Angioplasty, cardiology as the medical unit responsible for the discharge and a higher volume of activity (> 204 AMI) were all significantly (p < 0.001) associated with lower mortality, risk of development of heart failure and RSRRs.
Angioplasty, cardiology as the medical unit responsible for the discharge and a higher volume of activity explain variability in CDs readmission rates after AMI, which can have implications for strategies to reduce readmissions rates.
Significance of Comorbid Psychological Stress and Depression on Outcomes After Cardiac Rehabilitation
2016, American Journal of Medicine
Citation Excerpt :
Although it is plausible that a dose–response relationship does not exist, a wealth of data supports its presence in both retrospective studies and meta-analyses, and there is little reason to assume that the postcardiac rehabilitation population would alter such relationships. Lastly, it has been established that formal cardiac rehabilitation and exercise training (irrespective of age, sex, or body composition) increases aerobic capacity, and improves survival and prognosis22 through a variety of effects that include improved diabetic glucose control, better autonomic function, less hypertension, and reductions in psychological stress.9,25-28 These data show that despite the benefits of cardiac rehabilitation and exercise training, depression continues to significantly impact mortality.
Depression is associated with increased mortality in stable coronary heart disease. Cardiac rehabilitation and exercise training has been shown to decrease depression, psychological stress, and mortality after a coronary heart disease event. The presence of depression at completion of cardiac rehabilitation and exercise training is associated with increased mortality. However, it is unknown if depression with comorbid psychological risk factors such as anxiety or hostility confers an additional mortality disadvantage. We evaluated the mortality effect of anxiety and hostility on depression after cardiac rehabilitation and exercise training.
We studied 1150 patients with coronary heart disease following major coronary heart disease events who had completed formal cardiac rehabilitation and exercise training. Using Kellner questionnaires, stress levels were measured in 1 of 3 domains: anxiety, hostility, and depression (with an aggregated overall psychological stress score) and divided into 3 groups: nondepressed (n = 1072), depression alone (n = 18), and depression with anxiety or hostility (n = 60). Subjects were analyzed for all-cause mortality over 161 months of follow-up (mean 6.4 years) by National Death Index.
Depression after cardiac rehabilitation was not common (6.8%; mortality 20.8%) but when present, frequently associated with either anxiety or hostility (77% of depressed patients; mortality 22.0%). After adjustment for age, sex, ejection fraction, and baseline peak oxygen consumption, depression alone (hazard ratio [HR] 1.73, P = .04), as well as depression with comorbid psychological stress, was associated with higher mortality (HR 1.98, P = .03). Furthermore, our data showed an increased mortality when both anxiety and hostility were present in addition to depression after cardiac rehabilitation (HR 2.41, P = .04).
After cardiac rehabilitation, depression, when present, is usually associated with other forms of psychological stress, which confers additional mortality. More measures are needed to address psychological stress after cardiac rehabilitation.
Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence
2015, Preventive Medicine
Objective: Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence.
Methods: A systematic literature search was conducted examining associations between smoking status and CR referral, attendance and completion in peer-reviewed studies published through July 1st, 2014. For inclusion, studies had to report data on outpatient CR referral, attendance or completion rates and smoking status had to be considered as a variable associated with these outcomes.
Results: Fifty-six studies met inclusion criteria. In summary, a history of smoking was associated with an increased likelihood of referral to CR. However, smoking status also predicted not attending CR and was a strong predictor of CR dropout.
Conclusion: Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.
Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction
2014, American Journal of Medicine
Citation Excerpt :
Little is known about the association between cardiac rehabilitation participation and readmissions. In the early 1990s, patients participating in cardiac rehabilitation had lower readmission charges post-myocardial infarction compared with nonparticipants, because of lower incidence of hospitalizations and lower charges per hospitalization.9 Although a randomized controlled trial would be the most definitive way to examine the impact of cardiac rehabilitation participation on readmissions, no such trial exists.
Participation in cardiac rehabilitation has been shown to decrease mortality after acute myocardial infarction, but its impact on readmissions requires examination.
We conducted a population-based surveillance study of residents discharged from the hospital after their first-ever myocardial infarction in Olmsted County, Minnesota, from January 1, 1987, to September 30, 2010. Patients were followed up through December 31, 2010. Participation in cardiac rehabilitation after myocardial infarction was determined using billing data. We used a landmark analysis approach (cardiac rehabilitation participant vs not determined by attendance in at least 1 session of cardiac rehabilitation at 90 days post-myocardial infarction discharge) to compare readmission and mortality risk between cardiac rehabilitation participants and nonparticipants accounting for propensity to participate using inverse probability treatment weighting.
Of 2991 patients with incident myocardial infarction, 1569 (52.5%) participated in cardiac rehabilitation after hospital discharge. The cardiac rehabilitation participation rate did not change during the study period, but increased in the elderly and decreased in men and younger patients. After adjustment, cardiac rehabilitation participants had lower all-cause readmission (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.65-0.87; P < .001), cardiovascular readmission (HR, 0.80; 95% CI, 0.65-0.99; P = .037), noncardiovascular readmission (HR, 0.72; 95% CI, 0.61-0.85; P < .001), and mortality (HR, 0.58; 95% CI, 0.49-0.68; P < .001) risk.
Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes.
Remote Cardiac Rehabilitation With Wearable Devices
2023, Korean Circulation Journal

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^☆: Supported by the Vermont Cardiac Rehabilitation Research and Education Fund.

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Cardiac rehabilitation participation predicts lower rehospitalization costs☆

Abstract

Prog Cardiovasc Dis

Am J Cardiol

Am J Cardiol

Lancet

Health care expenditures for major diseases in 1980

Health Care Financing Rev

Scientific evidence of the value of cardiac rehabilitation services with emphasis on patients following myocardial infarction—section 1: Exercise conditioning component

J Cardiopulm Rehab

Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials

JAMA

An overview of randomized trials of rehabilitation with exercise after myocardial infarction

Circulation

A nurse rehabilitator's impact on patients with myocardial infarction

Med Care

Return to work after a myocardial infarction. Evaluation of planned rehabilitation and of a predictive rating scale

Med J Australia

Improvement of left ventricular contractile function by exercise training in patients with coronary artery disease

Circulation