Statewide collaboration aims to save lives by improving cardiac rehab participation
This year in the U.S., as many as one in three women and one in four men will be diagnosed with heart disease, and more than 1 million families will watch their loved one struggle through the toll of a coronary event or cardiac procedure.
Despite the prominence of cardiac diseases, too few patients and loved ones are familiar with cardiac rehabilitation, a life-changing program available to patients. A team of physicians, researchers, data analysts and engagement specialists from the Michigan Value Collaborative (MVC) are eager to heighten awareness of these programs and will host a special cardiac rehab workgroup during February’s Cardiac Rehabilitation Week.
The workgroup will take place on Feb. 16, from 1-2 p.m., featuring presentations from cardiac rehab expert Steven Keteyian, Ph.D., of Henry Ford Health System and patient advocate Greg Merritt.
MVC invites clinicians, health care staff and those interested in cardiac rehab utilization to attend and participate in the discussion that follows.
The workgroup is part of a larger weeklong campaign to increase awareness about cardiac rehab in the hope that patients’ medical teams and families encourage enrollment in the future. Partnering with MVC on the campaign is the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), a collaborative consortium of providers dedicated to improving quality of care and outcomes for cardiovascular patients across the state of Michigan.
Cardiac rehabilitation (CR) has a Class IA indication for recent cardiac-related events or procedures, meaning there is high-quality evidence that it is beneficial to patients. In fact, individuals who complete the full program of 36 sessions have a 47% lower risk of death and a 31% lower risk of heart attack than those who attend only one session. It also reduces hospital readmissions and saves thousands of dollars per patient per year of life saved. Nevertheless, CR is widely underutilized, with national utilization rates of only 20-30%.
“The evidence is clear,” said MVC codirector Mike Thompson, Ph.D., an assistant professor in the Department of Cardiac Surgery at Michigan Medicine. “Cardiac rehab extends life and improves the quality of life for patients with a recent cardiac-related event or procedure. Unfortunately, two out of every three Michiganders eligible for cardiac rehab never participate.”
It is for this reason that MVC wishes to equitably increase CR participation for all eligible individuals in Michigan, a task that requires strong partnerships.
As a Collaborative Quality Initiative (CQI), MVC works closely with fellow CQIs that have a clinical focus in the cardiac space. MVC, BMC2 and the Michigan Society for Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) each have unique assets to assist their respective members, which are complemented by joint ventures such as site visits with hospitals and the development of best practice guides.
MVC’s role in the CR space is two-fold. One is providing opportunities for MVC members to collaborate, and the second is preparation of reports using its unique multi-payer data sources. The MVC team supports collaboration for its member base of 100 hospitals and 40 physician organizations through events like the special cardiac rehab workgroup, which allow sites and clinicians to share solutions for common challenges. The reports that MVC prepares for members analyze claims data with time-specific hospital-level information on CR enrollment and completed visits within one year of discharge. This allows hospitals to benchmark their performance against peers and identify areas for improvement.
MVC analyst Jessica Yaser helps lead the MVC team’s efforts on CR and cites large variability in CR participation between hospitals.
“In claims data we can assess both initiation and adherence – whether and when someone starts cardiac rehab, and how long they keep going,” Yaser said. “There’s a huge amount of variation in cardiac rehab rates across many dimensions — across hospitals, across qualifying events and across payers. The hospital with the highest rate of cardiac rehab after coronary artery bypass graft surgery (CABG) succeeds at sending 75% of their CABG patients to cardiac rehab, while another only sends 28% of their CABG patients. This variation shows that it is possible to reach high cardiac rehab rates, and hospitals can learn from each other to make systemic improvements to get more patients to life-changing (and cost-saving) cardiac rehab programs.”
One reason CR participation differs so significantly across hospitals is a lack of awareness about what it entails and its value. Recent data published by MVC and BMC2 highlight a large disparity between CR referral and CR attendance.
“Physician endorsement and referral play a critical role in a patient’s decision to participate in cardiac rehab,” said Devraj Sukul, M.D., M.S., interventional cardiologist and associate director of BMC2. “Improving awareness of the benefits of cardiac rehab among patients and physicians will save lives, improve health, and improve the sustainability of health care in Michigan.”
Cardiac rehab is a comprehensive program encompassing a variety of activities and topics. Despite most people believing that CR amounts to little more than supervised exercise, it covers topics such as smoking cessation, nutrition, mental health, and skills training for heart-healthy lifestyles after a cardiac event. It also incorporates a sense of community with others who are experiencing a similar life event and shared challenges.
The MVC team hopes that its CR reports and educational events reach the family members and physicians of future patients so they may remember CR when it counts and encourage their loved one to sign up. Doing so would save thousands of lives.
Those interested in attending the workgroup can register in advance here.