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Cardiac rehabilitation (CR) remains dramatically underused among US veterans, as < 11% of eligible patients attend a single session and usage appears to be declining over time, a recently published retrospective cohort study reported.
CR use is much lower among eligible patients across the US Department of Veterans Affairs (VA) compared with Medicare (10.4% vs. 28%, respectively), reported researchers at Veterans Affairs Connecticut Healthcare System and Yale School of Medicine, in JACC: Advances.
The overall CR rate in the VA was lower than the 13.2% reported in a 2018 study. And while there was no significant difference in use between men and women, veterans from the poorest neighborhoods were less likely to take advantage of CR compared with veterans from the wealthiest neighborhoods (adjusted odds ratio, 0.82; P < .001).
“As providers, the time to act is now,” Merilyn Varghese, MD, MSc, said in an interview with Federal Practitioner. “We need to urgently get more of our veterans to cardiac rehab.”
As Varghese explained, “CR is a preventive intervention that has been shown to improve quality of life and reduce mortality and hospitalizations for patients with specific cardiac conditions.”
Patients may be eligible if they have experienced myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG), heart transplant, valve surgery, stable angina, or stable heart failure.
“CR combines multiple aspects of cardiac care such as exercise training, medication management, and behavioral assessments,” Varghese said. “For example, patients who have had a heart attack may have challenges in getting back to an exercise routine, managing new medications, and adjusting to life after such an event. CR can help bridge the gap between hospital to home.” In-person CR typically includes 3 sessions per week for 12 weeks.
In 2024, a systematic review and meta-analysis reported that CR reduces all-cause mortality (relative risk, 0.74): “These results support the utilization of CR as a critical element in the management of further secondary prevention of CVDs (cardiovascular diseases).”
Examining VA Data
Researchers conducted the 2026 study “to better understand the current landscape of CR among veterans, particularly among women veterans who comprise a significant part of the veteran population but have previously been underrepresented in research,” Varghese said.
“Women veterans also share a different burden of cardiovascular risk factors, so understanding CR participation among both women and men veterans was of particular interest.”
The study tracked 82,496 VA-enrolled veterans eligible for CR from 2021-2023 (3.6% women). Average age of participants were 64.0 years among women and 71.5 years among men. Among women, 58.3% were White, and 31.8% were Black, and 2.24% were Asian. Among men, 71.9% were White, 18.8% were Black, and 2.3% were Asian.
The rates of CR participation were low among both men (10.4%) and women (10.2%). Older people and Black patients were less likely to take part in CR than younger people and White patients, according to the study. Those who underwent CABG and PCI were more likely to participate in CR compared with those who had heart attacks only.
As for the gap in use between the wealthiest and poorest neighborhoods, Varghese said: “Area deprivation may compound some of the other barriers to CR access, including transportation difficulties, work responsibilities, and out-of-pocket costs.”
How can CR uptake be improved? “A key first step is understanding who can be referred, and second, to spend time discussing the importance of attending with veterans,” Varghese said. “Studies have shown that provider engagement and championing of CR are important positive facilitators that encourage CR participation.
“The VA has been at the forefront of innovation with the home-based CR program that offers veterans a way to attend CR remotely,” she added. “Expanding such novel methods of CR delivery is likely part of the solution to expand CR access.”
Outside Perspective: Make Referrals the Default
Justin Bachmann, MD, MPH, staff physician and research scientist at VA Tennessee Valley Healthcare System, told Federal Practitioner that CR is an American College of Cardiology/American Heart Association Class I recommended secondary prevention therapy following MI, PCI, and CABG “with strong evidence for reduced cardiovascular mortality and improved function and quality of life.”
Still, CR “has been persistently underused for decades as travel, cost, scheduling, and uneven geographic capacity create real logistical barriers,” said Bachmann, who serves as the medical director of a VA Office of Rural Health home-based CR program.
Bachmann praised the study methodology and offered this advice to colleagues: “Embed CR referral in the post-MI, post-PCI, and post-CABG order sets so that referral is the default. Scale home-based CR well beyond the roughly 40 sites where it is currently available, and track facility-level referral and enrollment rates as quality measures.”
Preventive cardiology specialist Randal J. Thomas, MD, professor of Medicine at the Mayo Clinic in Rochester, Minn., echoed the importance of physician referral Federal Practitioner.
“Patients can’t actually participate [directly] in most programs. They must have a physician referral,” he said. “The physician referral and the strength of referral is key. If a physician says, ‘You can go there if you want, but it’s not that important,’ the patients aren’t going to go.”
Outside Perspective: VA Deserves Blame
“The VA lags far behind most medical systems,” according to Quinn R. Pack, MD, associate professor of medicine at the University of Massachusetts Chan Medical School-Baystate. “Some of this is probably the patient population—more mental health problems, more smoking, more disease. But I’d squarely put most of this on the VA health system. They haven’t created the systems of care that make attending cardiac rehabilitation easy, reliable, and consistent.”
He noted that that automatic referral combined with a bedside visit by a liaison such as a representative of a CR program can double or triple enrollment.
“When physicians and nurses really encourage patients to go [to CR], these words are powerful,” Pack said. “When a patient enrolls in cardiac rehabilitation, we help them form new habits of exercise.”
No study fundings are reported. The Varghese discloses a relationship with the Veterans Health Administration. Other study authors had no disclosures. Bachmann disclosed a relationship with the VA. Pack and Thomas have no disclosures.
Cardiac rehabilitation (CR) remains dramatically underused among US veterans, as < 11% of eligible patients attend a single session and usage appears to be declining over time, a recently published retrospective cohort study reported.
CR use is much lower among eligible patients across the US Department of Veterans Affairs (VA) compared with Medicare (10.4% vs. 28%, respectively), reported researchers at Veterans Affairs Connecticut Healthcare System and Yale School of Medicine, in JACC: Advances.
The overall CR rate in the VA was lower than the 13.2% reported in a 2018 study. And while there was no significant difference in use between men and women, veterans from the poorest neighborhoods were less likely to take advantage of CR compared with veterans from the wealthiest neighborhoods (adjusted odds ratio, 0.82; P < .001).
“As providers, the time to act is now,” Merilyn Varghese, MD, MSc, said in an interview with Federal Practitioner. “We need to urgently get more of our veterans to cardiac rehab.”
As Varghese explained, “CR is a preventive intervention that has been shown to improve quality of life and reduce mortality and hospitalizations for patients with specific cardiac conditions.”
Patients may be eligible if they have experienced myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG), heart transplant, valve surgery, stable angina, or stable heart failure.
“CR combines multiple aspects of cardiac care such as exercise training, medication management, and behavioral assessments,” Varghese said. “For example, patients who have had a heart attack may have challenges in getting back to an exercise routine, managing new medications, and adjusting to life after such an event. CR can help bridge the gap between hospital to home.” In-person CR typically includes 3 sessions per week for 12 weeks.
In 2024, a systematic review and meta-analysis reported that CR reduces all-cause mortality (relative risk, 0.74): “These results support the utilization of CR as a critical element in the management of further secondary prevention of CVDs (cardiovascular diseases).”
Examining VA Data
Researchers conducted the 2026 study “to better understand the current landscape of CR among veterans, particularly among women veterans who comprise a significant part of the veteran population but have previously been underrepresented in research,” Varghese said.
“Women veterans also share a different burden of cardiovascular risk factors, so understanding CR participation among both women and men veterans was of particular interest.”
The study tracked 82,496 VA-enrolled veterans eligible for CR from 2021-2023 (3.6% women). Average age of participants were 64.0 years among women and 71.5 years among men. Among women, 58.3% were White, and 31.8% were Black, and 2.24% were Asian. Among men, 71.9% were White, 18.8% were Black, and 2.3% were Asian.
The rates of CR participation were low among both men (10.4%) and women (10.2%). Older people and Black patients were less likely to take part in CR than younger people and White patients, according to the study. Those who underwent CABG and PCI were more likely to participate in CR compared with those who had heart attacks only.
As for the gap in use between the wealthiest and poorest neighborhoods, Varghese said: “Area deprivation may compound some of the other barriers to CR access, including transportation difficulties, work responsibilities, and out-of-pocket costs.”
How can CR uptake be improved? “A key first step is understanding who can be referred, and second, to spend time discussing the importance of attending with veterans,” Varghese said. “Studies have shown that provider engagement and championing of CR are important positive facilitators that encourage CR participation.
“The VA has been at the forefront of innovation with the home-based CR program that offers veterans a way to attend CR remotely,” she added. “Expanding such novel methods of CR delivery is likely part of the solution to expand CR access.”
Outside Perspective: Make Referrals the Default
Justin Bachmann, MD, MPH, staff physician and research scientist at VA Tennessee Valley Healthcare System, told Federal Practitioner that CR is an American College of Cardiology/American Heart Association Class I recommended secondary prevention therapy following MI, PCI, and CABG “with strong evidence for reduced cardiovascular mortality and improved function and quality of life.”
Still, CR “has been persistently underused for decades as travel, cost, scheduling, and uneven geographic capacity create real logistical barriers,” said Bachmann, who serves as the medical director of a VA Office of Rural Health home-based CR program.
Bachmann praised the study methodology and offered this advice to colleagues: “Embed CR referral in the post-MI, post-PCI, and post-CABG order sets so that referral is the default. Scale home-based CR well beyond the roughly 40 sites where it is currently available, and track facility-level referral and enrollment rates as quality measures.”
Preventive cardiology specialist Randal J. Thomas, MD, professor of Medicine at the Mayo Clinic in Rochester, Minn., echoed the importance of physician referral Federal Practitioner.
“Patients can’t actually participate [directly] in most programs. They must have a physician referral,” he said. “The physician referral and the strength of referral is key. If a physician says, ‘You can go there if you want, but it’s not that important,’ the patients aren’t going to go.”
Outside Perspective: VA Deserves Blame
“The VA lags far behind most medical systems,” according to Quinn R. Pack, MD, associate professor of medicine at the University of Massachusetts Chan Medical School-Baystate. “Some of this is probably the patient population—more mental health problems, more smoking, more disease. But I’d squarely put most of this on the VA health system. They haven’t created the systems of care that make attending cardiac rehabilitation easy, reliable, and consistent.”
He noted that that automatic referral combined with a bedside visit by a liaison such as a representative of a CR program can double or triple enrollment.
“When physicians and nurses really encourage patients to go [to CR], these words are powerful,” Pack said. “When a patient enrolls in cardiac rehabilitation, we help them form new habits of exercise.”
No study fundings are reported. The Varghese discloses a relationship with the Veterans Health Administration. Other study authors had no disclosures. Bachmann disclosed a relationship with the VA. Pack and Thomas have no disclosures.
Cardiac rehabilitation (CR) remains dramatically underused among US veterans, as < 11% of eligible patients attend a single session and usage appears to be declining over time, a recently published retrospective cohort study reported.
CR use is much lower among eligible patients across the US Department of Veterans Affairs (VA) compared with Medicare (10.4% vs. 28%, respectively), reported researchers at Veterans Affairs Connecticut Healthcare System and Yale School of Medicine, in JACC: Advances.
The overall CR rate in the VA was lower than the 13.2% reported in a 2018 study. And while there was no significant difference in use between men and women, veterans from the poorest neighborhoods were less likely to take advantage of CR compared with veterans from the wealthiest neighborhoods (adjusted odds ratio, 0.82; P < .001).
“As providers, the time to act is now,” Merilyn Varghese, MD, MSc, said in an interview with Federal Practitioner. “We need to urgently get more of our veterans to cardiac rehab.”
As Varghese explained, “CR is a preventive intervention that has been shown to improve quality of life and reduce mortality and hospitalizations for patients with specific cardiac conditions.”
Patients may be eligible if they have experienced myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG), heart transplant, valve surgery, stable angina, or stable heart failure.
“CR combines multiple aspects of cardiac care such as exercise training, medication management, and behavioral assessments,” Varghese said. “For example, patients who have had a heart attack may have challenges in getting back to an exercise routine, managing new medications, and adjusting to life after such an event. CR can help bridge the gap between hospital to home.” In-person CR typically includes 3 sessions per week for 12 weeks.
In 2024, a systematic review and meta-analysis reported that CR reduces all-cause mortality (relative risk, 0.74): “These results support the utilization of CR as a critical element in the management of further secondary prevention of CVDs (cardiovascular diseases).”
Examining VA Data
Researchers conducted the 2026 study “to better understand the current landscape of CR among veterans, particularly among women veterans who comprise a significant part of the veteran population but have previously been underrepresented in research,” Varghese said.
“Women veterans also share a different burden of cardiovascular risk factors, so understanding CR participation among both women and men veterans was of particular interest.”
The study tracked 82,496 VA-enrolled veterans eligible for CR from 2021-2023 (3.6% women). Average age of participants were 64.0 years among women and 71.5 years among men. Among women, 58.3% were White, and 31.8% were Black, and 2.24% were Asian. Among men, 71.9% were White, 18.8% were Black, and 2.3% were Asian.
The rates of CR participation were low among both men (10.4%) and women (10.2%). Older people and Black patients were less likely to take part in CR than younger people and White patients, according to the study. Those who underwent CABG and PCI were more likely to participate in CR compared with those who had heart attacks only.
As for the gap in use between the wealthiest and poorest neighborhoods, Varghese said: “Area deprivation may compound some of the other barriers to CR access, including transportation difficulties, work responsibilities, and out-of-pocket costs.”
How can CR uptake be improved? “A key first step is understanding who can be referred, and second, to spend time discussing the importance of attending with veterans,” Varghese said. “Studies have shown that provider engagement and championing of CR are important positive facilitators that encourage CR participation.
“The VA has been at the forefront of innovation with the home-based CR program that offers veterans a way to attend CR remotely,” she added. “Expanding such novel methods of CR delivery is likely part of the solution to expand CR access.”
Outside Perspective: Make Referrals the Default
Justin Bachmann, MD, MPH, staff physician and research scientist at VA Tennessee Valley Healthcare System, told Federal Practitioner that CR is an American College of Cardiology/American Heart Association Class I recommended secondary prevention therapy following MI, PCI, and CABG “with strong evidence for reduced cardiovascular mortality and improved function and quality of life.”
Still, CR “has been persistently underused for decades as travel, cost, scheduling, and uneven geographic capacity create real logistical barriers,” said Bachmann, who serves as the medical director of a VA Office of Rural Health home-based CR program.
Bachmann praised the study methodology and offered this advice to colleagues: “Embed CR referral in the post-MI, post-PCI, and post-CABG order sets so that referral is the default. Scale home-based CR well beyond the roughly 40 sites where it is currently available, and track facility-level referral and enrollment rates as quality measures.”
Preventive cardiology specialist Randal J. Thomas, MD, professor of Medicine at the Mayo Clinic in Rochester, Minn., echoed the importance of physician referral Federal Practitioner.
“Patients can’t actually participate [directly] in most programs. They must have a physician referral,” he said. “The physician referral and the strength of referral is key. If a physician says, ‘You can go there if you want, but it’s not that important,’ the patients aren’t going to go.”
Outside Perspective: VA Deserves Blame
“The VA lags far behind most medical systems,” according to Quinn R. Pack, MD, associate professor of medicine at the University of Massachusetts Chan Medical School-Baystate. “Some of this is probably the patient population—more mental health problems, more smoking, more disease. But I’d squarely put most of this on the VA health system. They haven’t created the systems of care that make attending cardiac rehabilitation easy, reliable, and consistent.”
He noted that that automatic referral combined with a bedside visit by a liaison such as a representative of a CR program can double or triple enrollment.
“When physicians and nurses really encourage patients to go [to CR], these words are powerful,” Pack said. “When a patient enrolls in cardiac rehabilitation, we help them form new habits of exercise.”
No study fundings are reported. The Varghese discloses a relationship with the Veterans Health Administration. Other study authors had no disclosures. Bachmann disclosed a relationship with the VA. Pack and Thomas have no disclosures.