Author + information
- Received July 20, 2017
- Revision received October 10, 2017
- Accepted November 3, 2017
- Published online January 30, 2018.
- Justin M. Bachmann, MD, MPHa,∗ (, )
- Meredith S. Duncan, MAa,
- Ashish S. Shah, MDb,
- Robert A. Greevy Jr., PhDc,
- JoAnn Lindenfeld, MDa,
- Steven J. Keteyian, PhDd,
- Randal J. Thomas, MD, MSe,
- Mary A. Whooley, MDf,
- Thomas J. Wang, MDa and
- Matthew S. Freiberg, MD, MSca
- aDivision of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- bDepartment of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- cDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- dDivision of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
- eDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- fMeasurement Science Quality Enhancement Research Initiative, Department of Veterans Affairs, San Francisco, California
- ↵∗Address for correspondence:
Dr. Justin M. Bachmann, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Cardiovascular Research, Nashville, Tennessee 37205.
Objectives This study characterized cardiac rehabilitation (CR) use in ventricular assist device (VAD) recipients in the United States and the association of CR with 1-year hospitalization and mortality by using the 2013 to 2015 Medicare files.
Background Exercise-based CR is indicated in patients with heart failure with reduced ejection fraction, but no data exist regarding CR participation after VAD implantation.
Methods The study included Medicare beneficiaries enrolled for disability or age >65 years. The investigators identified VAD recipients by diagnosis codes and cumulated CR sessions occurring within 1 year after VAD implantation. Multivariable-adjusted Andersen-Gill models were used to evaluate the association of CR with 1-year hospitalization risk, and Cox regression was used to evaluate the association of CR with 1-year mortality.
Results There were 1,164 VADs implanted in Medicare beneficiaries in the United States in 2014. CR use was low, with 348 patients (30%) participating in CR programs. The Midwest had the highest proportion of VAD recipients who began CR (38%), whereas the Northeast had the lowest proportion of CR participants (25%). Each 5-year increase in age was associated with attending an additional 1.6 CR sessions (95% confidence interval [CI]: 0.7 to 2.5; p < 0.001). CR participation was associated with a 23% lower 1-year hospitalization risk (95% CI: 11% to 33%; p < 0.001) and a 47% lower 1-year mortality risk (95% CI: 18% to 66%; p < 0.01) after multivariable adjustment.
Conclusions Approximately one-third of VAD recipients attend CR. Although it is not possible to account fully for unmeasured confounding, VAD recipients who participate in CR appear to have lower risks for hospitalization and mortality.
This project was supported by Vanderbilt Clinical and Translational Science grant UL1 TR000445 from the National Center for Advancing Translational Sciences at the National Institutes of Health and grant K12HS022990 from the Agency for Healthcare Research and Quality. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of these agencies. Dr. Lindenfeld has been a consultant for Abbott, Relypsa, Resmed, CVRx, VWave, and Cardionomic; and has received grants from Novartis and AstraZeneca. Dr. Keteyian is a technical advisor to Nimble Heart. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Barry H. Greenberg, MD, served as Guest Editor for this paper.
- Received July 20, 2017.
- Revision received October 10, 2017.
- Accepted November 3, 2017.
- 2018 American College of Cardiology Foundation
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