{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:38:18Z","timestamp":1788572298816,"version":"build-2803163510"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Frailty before cardiovascular procedures is associated with poorer outcomes. While underutilized, cardiac rehabilitation (CR) is guideline-recommended for patients undergoing cardiovascular procedures and may help mitigate the effects of frailty. This study evaluated the association between preprocedural frailty and CR use, as well as the interaction of frailty and CR use on 1-year mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Medicare fee-for-service claims were queried for patients undergoing percutaneous or surgical revascularization or aortic valve replacement between July 2016 and December 2018. Patients who experienced mortality during the index admission or within 30 days of discharge were excluded. Patients were stratified into quartiles (Q1\u2013Q4) using the validated claims-based frailty index (CFI). CR use was defined as attending any CR session within 1 year of discharge. Unadjusted comparisons and multivariable analyses were used to evaluate the relationship between frailty and CR use (CFI-Q4 versus CFI-Q1). An inverse probability treatment weighting model was used to determine if there was an interaction between CR, frailty, and 1-year mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Overall CR use among the 501\u2009049 beneficiaries was 37.7%; the average age was 75.9 years (SD, 7.3), and 37.0% were female. Increasing frailty was associated with decreased CR use (CFI-Q1: 49.7%, CFI-Q2: 42.2%, CFI-Q3: 35.3%, and CFI-Q4: 23.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001; adjusted odds ratio\n                      <jats:sub>CFI-Q4<\/jats:sub>\n                      <jats:sub>versus CFI-Q1<\/jats:sub>\n                      , 0.63 [95% CI, 0.62\u20130.64]). Unadjusted 1-year mortality was higher with increasing frailty (CFI Q1: 2.5%, CFI-Q2: 5.1%, CFI-Q3: 9.0%, and CFI Q4: 16.9%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). After adjustment, the reduction in mortality associated with CR use was greater among frailer patients relative to less frail patients (CFI-Q4: 9.2% and CFI-Q1: 1.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). CR use was associated with a significantly reduced association between CFI and 1-year mortality (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Preprocedural frailty is associated with lower CR use despite greater absolute benefits on 1-year mortality. Increasing CR use of frail Medicare beneficiaries may reduce 1-year mortality after cardiac interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.125.012009","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T10:00:15Z","timestamp":1763719215000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Association Between Cardiac Rehabilitation and 1-Year Mortality by Frailty Level in Medicare Beneficiaries"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5430-5104","authenticated-orcid":true,"given":"Tyler M.","family":"Bauer","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery (T.M.B., H.H., D.S.L., F.D.P., M.P.T.), University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0890-0746","authenticated-orcid":true,"given":"Hechuan","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery (T.M.B., H.H., D.S.L., F.D.P., M.P.T.), University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0476-7212","authenticated-orcid":true,"given":"Maximilian","family":"Fleigner","sequence":"additional","affiliation":[{"name":"Oakland University William Beaumont School of Medicine, Auburn Hills, MI (M.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0416-9359","authenticated-orcid":true,"given":"Donald S.","family":"Likosky","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery (T.M.B., H.H., D.S.L., F.D.P., M.P.T.), University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4430-9969","authenticated-orcid":true,"given":"Francis D.","family":"Pagani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery (T.M.B., H.H., D.S.L., F.D.P., M.P.T.), University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4709-3390","authenticated-orcid":true,"given":"Devraj","family":"Sukul","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine (D.S.), University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Keteyian","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI (S.J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9992-593X","authenticated-orcid":true,"given":"Michael P.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery (T.M.B., H.H., D.S.L., F.D.P., M.P.T.), University of Michigan, Ann Arbor, MI."},{"name":"Center for Healthcare Outcomes and Policy (M.P.T.), University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2223-3652.2012.01.02"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy394"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001039"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.785501"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.5952"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2302291"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31823b5fee"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000675"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000547"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.09.070"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2010.08.009"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000492"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000537"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2019.07.001"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.08.001"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12030"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.2174\/1574884712666170710094842"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/14779072.2022.2035722"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.03.034"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000126"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0889-7204.2002.00614.x"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glx229"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glaa150"},{"key":"e_1_3_3_25_2","unstructured":"Kim DH Gautam N. SAS programs - claims-based frailty index. [Internet]. Harvard Dataverse. 2020. Accessed November 24 2025. http:\/\/dx.doi.org\/10.7910\/DVN\/HM8DOI"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005902"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.4657"},{"key":"e_1_3_3_28_2","unstructured":"Kesler P. Distressed communities. Economic innovation group. March 24 2022. Accessed November 4 2023. https:\/\/eig.org\/distressed-communities\/"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-316497"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2020.11.012"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.121.008242"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2023.05.044"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.02.080"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.21037\/tp.2018.02.04"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2018.07.001"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e328305df05"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317724574"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2019.08.032"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000076"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glad010"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glae094"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.02.063"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.007144"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2024.03.024"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjacc\/zuaf014"}],"updated-by":[{"DOI":"10.1161\/hcq.0000000000000145","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000}}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.125.012009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T19:00:29Z","timestamp":1765911629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.125.012009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":45,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.125.012009"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.125.012009","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"value":"1941-7713","type":"print"},{"value":"1941-7705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-02-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}