Support and Data for Virtual Rehab at Home
Support for Virtual Heart & Lung Rehab
AACVPR - Professional Society for Cardiac and Pulmonary Rehabilitation
AACVPR has long been advocating for access to more cardiac rehabilitation (CR) and pulmonary rehabilitation (PR), given that the uptake of these programs is low. Their advocacy efforts have addressed the need for more virtual, supervised cardiac and pulmonary rehabilitation.
American Heart Association, American College of Cardiology, and AACVPR
In their scientific statement: “We conclude that home-based CR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.”
CDC & CMS: Million Hearts Initiative
Million Hearts® exists for the sole purpose of saving more of the lives taken and protecting more of the lives impacted by heart disease and stroke in the United States. The goal is to prevent 1MM heart attacks by 2027. Cardiac rehabilitation is a core tenet and is sorely underused. (CDC Infographic.)
Health Systems and Providers
Many organizations and providers have written letters to CMS in support of virtual rehabilitation. Representative providers and health systems include:
CommonSpirit (Dignity / CHI)
Tampa General Hospital
Geisinger Health System
Baptist Health System (IN/KY)
Duke Health System
Beth Israel Deaconess Medical Center
Many more…
Non-profits & Industry Partners
Many partners support options that equip patients, providers, and health systems for better care to more patients. Supporters include:
Recora
Pritikin ICR
Ornish Lifestyle Medicine
Preventive Medicine Research Institute
Carda
Chanl
Many more…
Data and Evidence
Cardiac Rehab “Deserts” require virtual options for access
Due to the geographic variation in CR access, a significant portion of the U.S. population lives in CR deserts. More interventions are needed beyond brick-and-mortar CR facilities. (Journal of the American College of Cardiology)
Home-based CR increases longevity
Participating in home-based cardiac rehabilitation after a heart attack or cardiac procedure was associated with a 36% lower likelihood of death from heart-related complications. (Journal of the American Heart Association)
Home-based, virtual CR shows further reductions in the cost of care
Virtual CR has been demonstrated to significantly reduce readmissions, emergency department visits, and the total cost of care - above and beyond center-based programs. See Geisinger’s recent data on this.
220 CR facilities still closed across the U.S. and patient use is still -22%
We are worse off in helping heart disease as a result of the COVID-19 pandemic. A recent study looked at patterns of CR use among Medicare beneficiaries. We are markedly down from pre-pandemic levels (by 22%), and many facilities remain closed or have shuttered completely. Virtual CR is an alternative that needs to be preserved to achieve CDC goals of better utilization.
Fewer hospitalizations in home-based CR than in center-based CR
Home-based CR had lower hospitalization rates at 12 months after discharge than those who participated in a facility program. (Journal of the American Medical Association)
Sex and racial disparities in cardiac rehabilitation exist
Cardiac rehabilitation is something recommended for all eligible patients, regardless of sex or race. However studies have shown disparities in access and referral rates. Inequality in referral and access can be addressed with more home-based programs and more effective outreach.
This encapsulates the problem with CR Access: low use, high barriers, and no options in many areas. Blue and gray areas demonstrate very low uptake of CR.
8% complete a CR program. Engagement varies greatly based on race/ethnicity.
CR Participation remains down ~20% from pre-pandemic levels. (Whitepaper: COVID-19 Related Impacts on Cardiac Rehabilitation Utilization among Medicare Beneficiaries Merilyn S. Varghese, MD, Yang Song, MSc, Jiaman Xu, MPH, Dhruv S. Kazi, MD, MSc, MS)