The relationship between discharge location and cardiac rehabilitation use after cardiac surgery

Tyler M Bauer; Maximilian Fliegner; Hechaun Hou; Temilolaoluwa Daramola; Jeffrey S McCullough; Whitney Fu; Francis D Pagani; Donald S Likosky; Steven J Keteyian; Michael P Thompson

doi:10.1016/j.jtcvs.2024.03.024

The relationship between discharge location and cardiac rehabilitation use after cardiac surgery

J Thorac Cardiovasc Surg. 2024 Mar 22:S0022-5223(24)00278-2. doi: 10.1016/j.jtcvs.2024.03.024. Online ahead of print.

Affiliations

¹ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
² Oakland University William Beaumont School of Medicine, Auburn Hills, Mich.
³ Division of Cardiovascular Medicine, Henry Ford Health, Detroit, Mich.
⁴ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Mich. Electronic address: mthomps@med.umich.edu.

PMID: 38522574
DOI: 10.1016/j.jtcvs.2024.03.024

Abstract

Background: Cardiac rehabilitation (CR) is a guideline-recommended risk-reduction program offered to cardiac surgical patients. Despite CR's association with better outcomes, attendance remains poor. The relationship between discharge location and CR use is poorly understood.

Methods: This study was a nationwide, retrospective cohort analysis of Medicare fee-for-service claims for beneficiaries undergoing coronary artery bypass grafting and/or surgical aortic valve repair between July 1, 2016, and December 31, 2018. The primary outcome was attendance of any CR session. Discharge location was categorized as home discharge or discharge to extended care facility (ECF) (including skilled nursing facility, inpatient rehabilitation, and long-term acute care). Multivariable logistic regression models evaluated the association between discharge location, CR attendance, and 1-year mortality.

Results: Of the 167,966 patients who met inclusion criteria, 34.1% discharged to an ECF. Overall CR usage rate was 53.9%. Unadjusted and adjusted CR use was lower among patients discharged ECFs versus those discharged home (42.1% vs 60.0%; adjusted odds ratio, 0.66; P < .001). Patients discharged to long-term acute care were less likely to use CR than those discharged to skilled nursing facility or inpatient rehabilitation (reference category: home; adjusted odds ratio for long-term acute care, 0.36, adjusted odds ratio for skilled nursing facility, 0.69, and adjusted odds ratio for inpatient rehabilitation, 0.71; P < .001). CR attendance was associated with a greater reduction in adjusted 1-year mortality in patients discharged to ECFs (9.7% reduction) versus those discharged home (4.3% reduction).

Conclusions: In this national analysis of Medicare beneficiaries, discharge to ECF was associated with lower CR use, despite a greater association with improved 1-year mortality. Interventions aimed at increasing CR enrollment at ECFs may improve CR use and advance surgical quality.

Keywords: CABG; cardiac rehab; rehabilitation.