Kent State Assistant Professor of Epidemiology, Dr. Melissa Zullo, MA '98, MPH '03, is nearing completion of a two-year study on the use of cardiac rehabilitation by older adults. Findings are expected this summer in the $96,000 study, which was funded by the Agency for Healthcare Research and Quality. AHRQ_2_new
Zullo is using Medicare data on cardiac patients age 65 and older to examine relationships between disability, illness burden, post-hospital service use and rehabilitation. "We understand the benefits of formal cardiac rehab programs, but disparities exist," explains Zullo. "Services are underutilized by older adults, women, minorities and especially those who use post-hospital services like skilled nursing facilities and home health care," she adds.
"This study challenges the current model of cardiac rehab developed in the 1970s to prepare middle-aged males to return to work following myocardial infarction," she says. "Despite the changing demographics of cardiac patients – they're older and sicker, and there are more women – the current rehab model and reimbursement structure have not changed in 35 years."
The study is significant because it will describe the continuum of cardiac care; expand our knowledge of why older adults do not receive outpatient cardiac rehab services, beyond the known factors of age, gender, race and location; and examine the effect of clinical factors not traditionally considered, including disability, illness severity, comorbidity, complications, treatment and rehabilitation contraindications.
"Many of these clinical variables can be modified," Zullo says. "For example, we can introduce cardiac rehab principles earlier and improve disability so that it no longer acts as a barrier to older adults' participation in outpatient cardiac rehabilitation. In addition, time to rehab service use is not known and may vary for reasons related to disability and illness burden," she says.
"We will better understand relationships among disability, illness burden, use of cardiac rehab and time to rehab use by older persons after an infarction," says Zullo. "The study is comparing those using post-hospital services with those who do not use post-hospital services. This will help us recognize and overcome barriers to the continuum of cardiac care and to reduce the rate of rehospitalizations," Zullo adds.
Zullo's findings may support changes to the current Medicare cardiac rehab service reimbursement structure, to provide rehab care principles during hospitalization and post-hospital care. "We may be making a case for stricter guidelines and an earlier start to improve quality of life," she predicts.