Cardiac Rehab Greatly Benefits Frail Heart Patients, Suggests Study
USA: A large analysis of Medicare beneficiaries has found that frail patients undergoing coronary revascularization or aortic valve replacement gain significant benefit when referred to cardiac rehabilitation. Despite being less likely to be referred, frail patients experienced the greatest improvement in outcomes and survival when they participated in cardiac rehab.
A new study published in Circulation: Cardiovascular Quality and Outcomes by Tyler M. Bauer from the Department of Cardiac Surgery, University of Michigan, Ann Arbor, and colleagues highlights a critical gap in care: although cardiac rehabilitation (CR) is strongly recommended in guidelines, its use remains low—especially among the most vulnerable patients.
The research examined how preprocedural frailty influences referral to CR and assessed whether participation in the program impacts one-year mortality in older adults undergoing common cardiovascular procedures.
The investigators analyzed Medicare fee-for-service claims for more than 5 lakh beneficiaries who underwent either percutaneous coronary intervention, surgical coronary revascularization, or aortic valve replacement between July 2016 and December 2018. Individuals who died during the initial hospital stay or within 30 days of discharge were excluded to ensure that all participants had an opportunity to engage in rehabilitation. Frailty was assessed using a validated claims-based frailty index (CFI), and patients were stratified into four quartiles, ranging from the least frail (Q1) to the most frail (Q4).
Overall, only 37.7% of the 501,049 eligible patients attended at least one cardiac rehabilitation session within a year of discharge. The average age of the cohort was 75.9 years, and 37% were women.
The key findings of the study were as follows:
- Frailty was inversely related to participation in cardiac rehabilitation, with CR attendance decreasing as frailty increased.
- Approximately 49.7% of the least frail patients joined CR, whereas only 23.7% of the most frail patients did so.
- Even after adjusting for various factors, the most frail group remained significantly less likely to receive CR referrals, with an adjusted odds ratio of 0.63 compared to the least frail group.
- One-year mortality rose sharply with frailty, ranging from 2.5% in the least frail patients to nearly 17% in the most frail group.
- CR participation provided the greatest survival benefit to frail patients.
- After adjustments, CR use was associated with a 9.2% reduction in one-year mortality among the most frail patients, compared with a 1.7% reduction in the least frail group.
- The inverse probability treatment weighting model demonstrated that CR substantially weakened the link between increasing frailty and risk of death.
The findings highlight a paradox in current cardiovascular care—patients who stand to gain the greatest survival advantage from cardiac rehabilitation are the least likely to receive it.
According to the authors, increasing CR utilization among frail Medicare beneficiaries could meaningfully lower one-year mortality after major cardiac interventions. The study strongly supports efforts to expand CR access, improve referral practices, and integrate frailty assessments into routine post-procedure care.
Reference:
Bauer TM, Hou H, Fleigner M, Likosky DS, Pagani FD, Sukul D, Keteyian SJ, Thompson MP. Association Between Cardiac Rehabilitation and 1-Year Mortality by Frailty Level in Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes. 2025 Nov 21:e012009. doi: 10.1161/CIRCOUTCOMES.125.012009. Epub ahead of print. PMID: 41268666.
Next Story