Tuesday, May 14, 2019 Study: Patients in Cardiac Rehab Are Older, Less Healthy, and Have More Diverse Needs Than Patients 20 Years Ago The use of cardiac rehabilitation (CR) has grown over time, but with that growth comes changes to patient demographics that present new challenges to providers, say researchers who studied the CR patient population in 1 health system over 2 decades. They describe today's CR patients as older, more overweight, and having a higher prevalence of coronary risk factors than CR patients in the past, with an expanded range of reasons for receiving CR that makes the population more diverse than ever. The study analyzed data from 5,396 patients who received CR at the University of Vermont Medical Center over a 20-year period between 1996 and 2015, taking in a host of variables, including the reason for participation in CR, the presence of comorbidities, BMI, age, sex, and medications taken. Results were published in the Journal of Cardiopulmonary Rehabilitation and Prevention (abstract only available for free). Among the findings: The average age of CR patients changed from 60.8 to 64.2 over the study period—an average yearly increase of 0.23 years. The number of CR patients 65 and older grew at an average yearly rate of 0.6%, while the yearly growth rate for patients 75 and older grew by 0.4%. Women, while still underrepresented, are a growing part of the CR population, and now make up 29.6% of patients, compared with 26.8% in 1996. The percentage of patients considered obese (BMI of 30 or more) increased from 33.2% to 39.6%, reflecting an average yearly increase of 0.5%. While mean weight and waist circumference didn't change, researchers attribute the more steady rates to the growing number of women receiving CR, which tamped down the rise of overall averages. When waist circumference and weight were controlled for sex, both were shown to have increased significantly over time. The prevalence of cardiac risk factors increased in several areas. The rate of diabetes rose from 17.3% to 21.7% of patients, while the percentage of patients with hypertension increased from 51% to 62.5%. The number of patients reporting current smoking also increased, from 6.6% to 8.4%. Both diabetes and smoking rates were about the same between men and women, but women had an 11% higher rate of hypertension. The underlying reasons for receiving CR were among the most dramatic shifts noted by researchers, with the percentage of heart valve replacement patients rising from 0% to 10.6% of the overall CR population. Patients receiving CR as part of treatment for myocardial infarction also increased to 39.6% of the CR population, compared with 29.7% in 1996. At the same time, the percentage of coronary bypass patients decreased significantly, from 37.2% to 21.6%, as did angina patients (5.4% to 1.5%). The use of cardiovascular medications has also increased, with the most dramatic change being in the use of statins by 98.7% of the CR population. Statin use was at 63.6% in 1996. Despite its growth, authors describe CR as still "underutilized," with only 35.5% of people who survive a myocardial infarction participating. Authors say that the wider use of CR is fueling at least some of the changes in patient characteristics, with heart valve replacement patients having a seemingly significant impact. The valve replacement patients were, on average, 2.3 years older than other CR patient groups, with a higher percentage of women, lower obesity rates, and generally lower prevalence of cardiac risk factors. As an example of the way valve replacement patients may be shifting overall numbers, authors point out that when valve replacement patients are taken out of the total CR population, the obesity rate jumps from 39.2% to 41.2%. Authors acknowledge that their study is limited by its focus on a single health system with a "relatively homogeneous" population, and a less-than-comprehensive range of diagnostic categories included. They assert, however, that the changes observed over time need to continue to be monitored for future trends—and should inform current practice. "Given the increase in patient heterogeneity, programs could benefit from having staff with diverse skill sets and able to handle the unique needs of patients with different medical needs," they write. "The ability to individualize patient treatment plans will need to increase. Patient complexity will also differ, suggesting a potential need for increasing staffing ratios." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.