{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T17:38:58Z","timestamp":1784482738319,"version":"3.55.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"crossref","award":["899763"],"award-info":[{"award-number":["899763"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000050","name":"HHS | NIH | National Heart, Lung, and Blood Institute","doi-asserted-by":"crossref","award":["R01HL157530"],"award-info":[{"award-number":["R01HL157530"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Richard A and Susan F Smith Center for Outcomes Research in Cardiology"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The impact of the COVID-19 pandemic on participation in and availability of cardiac rehabilitation (CR) is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Among eligible Medicare fee-for-service beneficiaries, we evaluated, by month, the number of CR sessions attended per 100\u2009000 beneficiaries, individuals eligible to initiate CR, and centers offering in-person CR between January 2019 and December 2021. We compared these outcomes between 2 periods: December 1, 2019 through February 28, 2020 (period 1, before declaration of the pandemic-related national emergency) and October 1, 2021 through December 31, 2021 (period 2, the latest period for which data are currently available).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              In period 1, Medicare beneficiaries participated in (mean\u00b1SD) 895\u00b184 CR sessions per 100\u2009000 beneficiaries each month. After the national emergency was declared, CR participation sharply declined to 56 CR sessions per 100\u2009000 beneficiaries in April 2020. CR participation recovered gradually through December 2021 but remained lower than prepandemic levels (period 2: 698\u00b129 CR sessions per month per 100\u2009000 beneficiaries,\n              <jats:italic>P<\/jats:italic>\n              =0.02). Declines in CR participation were most marked among dual Medicare and Medicaid enrollees and patients residing in rural areas or socially vulnerable communities. There was no statistically significant change in CR eligibility between the 2 periods. Compared with 2618\u00b15 CR centers in period 1, there were 2464\u00b17 in period 2 (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). Compared with CR centers that survived the pandemic, 220 CR centers that closed were more likely to be affiliated with public hospitals, located in rural areas, and serve the most socially vulnerable communities.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The COVID-19 pandemic was associated with a persistent decline in CR participation and the closure of CR centers, which disproportionately affected rural and low-income patients and the most socially vulnerable communities. Innovation in CR financing and delivery is urgently needed to equitably enhance CR participation among Medicare beneficiaries.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.122.009618","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T09:00:16Z","timestamp":1667206816000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Cardiac Rehabilitation and the COVID-19 Pandemic: Persistent Declines in Cardiac Rehabilitation Participation and Access Among US Medicare Beneficiaries"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1121-7566","authenticated-orcid":true,"given":"Merilyn S.","family":"Varghese","sequence":"first","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.)."},{"name":"Harvard Medical School, Boston, MA (M.S.V., R.W.Y., D.S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8405-7386","authenticated-orcid":true,"given":"Alexis L.","family":"Beatty","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Division of Cardiology, Department of Medicine, University of California, San Francisco (A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Song","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaman","family":"Xu","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9417-6370","authenticated-orcid":true,"given":"Laurence S.","family":"Sperling","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (L.S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-8093","authenticated-orcid":true,"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Keteyian","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin W.","family":"McConeghy","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (K.W.M.)."},{"name":"Center of Innovation Long-Term Services and Supports, Providence Veterans Administration Medical Center, RI (K.W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Penko","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco (J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0564-4468","authenticated-orcid":true,"given":"Robert W.","family":"Yeh","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.)."},{"name":"Harvard Medical School, Boston, MA (M.S.V., R.W.Y., D.S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose F.","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Department of Health Policy &amp; Management, Harvard T.H. Chan School of Public Health, Boston, MA (J.F.F.)."},{"name":"Division of General Internal Medicine, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA (J.F.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2834-2024","authenticated-orcid":true,"given":"Wen-Chih","family":"Wu","sequence":"additional","affiliation":[{"name":"Providence VA Medical Center and the Miriam Hospital Cardiovascular Rehabilitation Center, RI (W.-C.W.)."},{"name":"Departments of Medicine, Epidemiology and Center for Global Cardiometabolic Health, Brown University, Providence, RI (W.-C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9510-2979","authenticated-orcid":true,"given":"Dhruv S.","family":"Kazi","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. 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