July 29th, 2014
Cardiac Rehab for Heart Failure Patients: The CMS Is Convinced — Are You?
Ileana Piña, MD, MPH and John Ryan, MD
CardioExchange’s John Ryan interviews Dr. Ileana Piña about her work in HF-ACTION and how it relates to the recent approval by the CMS to expand potential Medicare coverage of cardiac rehabilitation by about two million people. Dr. Piña’s work is published here in the Journal of the American College of Cardiology, and the New York Times coverage of the CMS approval can be found here.
Ryan: Because HF-ACTION failed to meet its primary endpoint, it can be regarded as a “negative” study. With this in mind, can you talk us through this approval process?
Piña: The Centers for Medicare & Medicaid Service (CMS) are most interested in improvements in the patient’s quality of life — which can be inferred from the significant increases in 6-minute walk distance and cardiopulmonary exercise time in HF-ACTION — and in safety, which was also demonstrated in the trial. Additionally, the analysis published in JACC showing the relationship between adherence and quantity of exercise with a positive relation to the primary endpoint probably sealed it for them. We had gone to CMS when we started the trial and kept them informed as we continued and completed it.
Ryan: With the increasing use of “wearables,” do you expect the compliance and monitoring of exercise in heart failure to change, and how will this affect the need for on-site cardiac rehab?
Piña: I don’t expect that wearables will really alter compliance rates significantly. You still need a “mother ship” to recommend their use and to give a prescription, and then there is no CMS coverage, that I know of, for heart failure rehabilitation at home.
Ryan: How do you discuss the risks of exercise with your heart failure patients?
Piña: The risks are small and the benefits are large. We discuss the importance of starting slow and building up; and the need for warm up,cool down, and lots of patience to see the results. I reassure patients about the safety of exercise and how much better overall they may feel with the increased energy and physical independence that result from it.
NEJM Journal Watch — Recent Cardiology Articles- Does Lowering High Childhood Lipid Levels Prevent Adverse Cardiovascular Events in Adulthood?
- Self-Expanding Supraannular Valve vs. Balloon-Expandable Valve in TAVR for Small Aortic Annulus
- A New TAVR Prosthesis for Aortic Regurgitation Shows Promise
- Aprocitentan, a Newly Approved Drug for Resistant Hypertension
- Preventive PCI of Vulnerable Plaques Linked to Fewer Cardiac Events