Key Points:
- Low-SES patients are less likely to attend CR following hospitalization for a major cardiovascular event and are more likely to be readmitted compared to those with higher SES.
- The HeLP study found that low-SES adults who were randomized to weekly calls from a case manager, financial incentives, or both had higher rates of post-discharge CR attendance compared to usual care.
Patients with lower socioeconomic status (SES) are more likely to be readmitted following a major cardiac event. While cardiac rehabilitation (CR) has been shown to reduce this risk, patients who are socioeconomically disadvantaged are less likely to attend these programs.
On April 7, 2024, the principal results of the “Incentives and Case Management to Improve Cardiac Care: the Healthy Lifestyle Program (HeLP)” were presented at ACC Scientific Sessions 2024. The purpose of this study was to compare the efficacy of a care management protocol, financial incentives, or both in improving CR attendance compared to usual care among low-SES adults following recent cardiovascular hospitalization.
This trial randomized CR-eligible low-SES adults admitted to the hospital for a major cardiovascular condition in a 3:3:3:2 fashion to the intervention arms or usual care. The case management protocol started in the hospital with an in-depth needs assessment followed by weekly standing phone calls. The financial incentive started at a $20 baseline and was increased by $2 for every session attended, with a reset back to baseline for unexcused absences. The combination arm received both interventions. The primary outcome was CR attendance rates.
Of the 314 assessed patients, 2019 were randomized and 192 included in the analysis (8% withdrawal rate). Overall, the average age was 58 and 35% were female. The population had multiple markers of elevated risk, including high rates of prior cardiac hospitalization, current smoking, and low educational attainment. The most common reasons for admission were coronary revascularization (71%), valvular intervention (12%), and heart failure (11%). Those randomized to the intervention arms had significantly higher CR attendance rates than usual care. The combination arm had the highest rates of completion of 30 CR sessions (62%), followed by the incentive arm (42%), case management arm (25%), and usual care (11%) (p<0.001 for trend). Limitations of this study include lack of clinical or functional endpoints.
Diann Gaalema, PhD, of University of Texas concluded: “These interventions, especially in combination, can significantly improve CR attendance. Larger trials are required to test the effect of increased attendance on outcomes.”