Cardiac Rehabilitation Use in Minnesota
What is cardiac rehabilitation?
Cardiac Rehabilitation (CR) is an evidence-based secondary prevention program designed to improve cardiovascular health after a qualifying cardiac event. In outpatient CR, patients are assigned up to 36 medically supervised sessions customized to address each patient’s physical fitness, nutrition, and medication use, modify cardiovascular risk factors, as well as enhance chronic disease self-management and provide psychosocial support.
Find out more about CR and what MDH is doing to encourage more participation: Cardiac Rehabilitation.
What are qualifying events (QE) for cardiac rehabilitation?
The primary cardiac events that qualify patients for cardiac rehab include acute myocardial infarction (AMI), coronary artery bypass graft (CABG) surgery, heart valve repair or replacement, percutaneous coronary intervention (PCI) and heart or heart-lung transplant. MDH identified these patients, as well as CR services, using a published surveillance methodology designed by the Million Hearts® collaborative. Eligible patients, events, and CR services were identified through diagnosis or procedure codes in their medical claims records. For a detailed description of the methods and codes used, visit Million Hearts Outpatient Cardiac Rehabilitation Use Surveillance Methodology (PDF). Secondary qualifying events that can qualify patients for CR include stable angina and chronic stable congestive heart failure. Because participation in CR for patients with these secondary qualifying events is low, we limited this dashboard to data on patients with primary qualifying events only.
Data source
The data in this dashboard comes from claims data in the Minnesota All Payer Claims Database (MN APCD), which contains health care claims for a majority of Minnesotans. This dashboard continues the work published by MDH in 2023: Surveillance of the Initiation of, Participation In, and Completion of Cardiac Rehabilitation in Minnesota 2017-2018. These results are for patients with qualifying events in 2020, which may be impacted by the first year of the COVID-19 pandemic. Visit How to Use Chronic Disease Data to learn more.
Cardiac rehabilitation measures for Minnesota
The table below shows the statewide performance on a number of measures related to CR enrollment, initiation, participation, and completion. Measures provided align with those recommended by several organizations, including the Centers for Disease Control and Prevention (CDC), American College of Cardiology (ACC), American Heart Association (AHA), and National Committee for Quality Assurance (NCOA).
Cardiac rehabilitation by region
To show differences in CR metrics across Minnesota, the state is divided into 15 distinct geographies based on the first three digits of the patients’ home zip code. Regions 556 and 557 are adjacent to each other and were combined because of small population. The largest community within each zip code area is listed in the tables. To see all regions and measures in one chart, view the Heat Chart.
Missed opportunities chart
While evidence shows that a full dose of outpatient CR (up to 36 sessions) leads to the best outcomes for patients, providers work directly with patients to monitor their progress during CR to meet health goals, which may be achieved before 36 sessions are completed. To inform local, regional, and statewide planning and goal setting, we have calculated the number of potential CR sessions that do not take place as “Missed Opportunities.”
These data are presented in multiple ways:
- The number of patients who are getting no CR at all
- The number of additional sessions that could have occurred if all patients received CR
You can view the number of sessions not delivered by CR programs which informs staffing and physical resources at the CR program sites. This can be viewed with the goal of all patients getting 12, 24, or 36 sessions.
Cardiac rehabilitation by qualifying event type
The chart below shows differences in CR enrollment, initiation, participation, and completion measures by the type of qualifying event (QE). It includes patients by individual qualifying event and combinations of events and procedures, including acute myocardial infarction with coronary artery bypass graft surgery (AMI + CABG) and acute myocardial infarction with percutaneous coronary intervention (AMI + PCI), and patients with two or more procedures. These categories are not mutually exclusive and patients are represented in each of the individual or combination qualifying events that they experienced. The number of heart and heart-lung transplants is very low, so we are unable to report for this qualifying event.
Cardiac rehabilitation by patient characteristics
Use of cardiac rehabilitation is also impacted by patient characteristics. Insurance coverage and where a person lives can limit their access to CR services. The charts below show differences in CR measures by demographics, insurance type, community characteristics, and distance to the nearest CR program location.
Contact us
For more information, contact health.heart@state.mn.us