April 13, 2021
Research builds on study that found cardiac rehabilitation also reduces post-stroke deaths
Stroke survivors who completed a Stroke Recovery program that included modified cardiac rehabilitation significantly reduced their chances of ending up back in the hospital in the first year after their stroke, according to a just-published study by Hackensack Meridian JFK Johnson Rehabilitation Institute. Widely offering this post-stroke rehabilitation could result in significant savings to the Center for Medicare and Medicaid Services (CMS), possibly over $1 billion annually.
The study published in the American Journal of Physical Medicine & Rehabilitation found a 22 percent reduction in hospital readmissions among stroke patients who completed the JFK Johnson Stroke Recovery Program compared to those who did not participate.
The researchers concluded that the added costs of the Stroke Recovery Program could be more than offset by what CMS could save by reducing post-stroke hospital readmissions.
The latest research builds on the ongoing Stroke-HEARTTM Trials at JFK Johnson Rehabilitation Institute, which previously showed that the Stroke Recovery Program could significantly reduce deaths in the first year after a stroke and also improve overall functional outcomes.
“We have shown that comprehensive rehabilitation for stroke patients can save lives and improve the quality of life of stroke survivors,” said Sara J. Cuccurullo, M.D., chair and medical director, JFK Johnson and a Co-Principal Investigator of the study. “Now we’ve shown that we can also reduce readmissions and overall health care costs.”
The cost to CMS of conventional care for stroke patients (traditional outpatient therapy and average hospital readmissions) is estimated at $9.67 billion annually. But using the Stroke Recovery Program and, as a result, reducing hospital readmissions, would reduce overall costs to $8.55 billion, the study concluded.
The JFK Johnson Stroke Recovery Program (SRP) provides 36 sessions of medically monitored interval cardiovascular training — as well as follow-up visits with a Physical Medicine and Rehabilitation physician along with psychological, nutritional and educational support and risk factor (such as smoking, diet and exercise) management. This is in addition to standard physical, occupational and speech therapy.
Patients who did not participate in the program received the standard of care, which includes physical, occupational and speech therapy, and follow up with their community physician.
The most recent study of the Stroke-HEARTTM Trials followed 193 stroke survivors discharged from the JFK Johnson Rehabilitation Institute, an inpatient facility, between 2015 and 2017. The patients who completed the program were matched exactly (stroke type, gender, race, age, baseline functional scores and medical complexity) with patients who did not complete the program.
Among those who did not participate in the program, 67 percent were readmitted to the hospital in the first year after their stroke. In contrast, 45 percent of the people who completed the program were readmitted to the hospital. People who completed the program reduced their chances of being re-hospitalized by 22 percent.
The long-term outcome for patients hospitalized for stroke can be dire. The overall chances that a person admitted to the hospital after a stroke will die within the year is 31.1 percent, according to the Get With The Guidelines®– Stroke program of the American Heart Association.
Stroke is a leading cause of disability and the fifth leading cause of death in the United States. Nationally, stroke affects an estimated 795,000 people per year. Fifteen to 30 percent of stroke survivors experience severe disability.
“In the United States, we’re not doing enough to prevent disability and death among stroke patients. We’re not doing enough to help them lead healthier lives,” said Talya Fleming, M.D., director, Aftercare and Stroke Recovery Program at JFK Johnson and Co-Principal Investigator of the study. “We can and must do better,” she said.
Dr. Fleming said stroke survivors often have high blood pressure, diabetes, high cholesterol, a history of smoking and/or an irregular heartbeat. Many have a sedentary lifestyle and a poor diet.
“The Stroke Recovery Program provides the structure to help our stroke patients adopt behavioral and lifestyle changes to lead healthier lives,” Dr. Fleming said.
The first study of the Stroke-HEARTTM Trials looked at overall mortality. It found that those who did not complete the Stroke Recovery Program were nine times more likely to die than those who did complete the program. The study also found people in the program significantly improved their cardio vascular performance over 36 sessions and had improved function in measures of daily activities.
CMS currently pays for 36 sessions of cardiovascular rehabilitation for patients who experience heart attacks, but does not pay for cardiovascular rehabilitation for those who experience stroke — even though both events involve the vascular system.
The researchers of the Stroke-HEARTTM Trials hope that CMS will in the future fund a comprehensive cardiac rehabilitation program for stroke patients the same way the government insurer funds a similar program for patients who have sustained a cardiac event. The Trials also are proving that stroke patients are capable of participating in intensive cardiovascular conditioning despite their functional deficits.
“There was this thinking that you could not get stroke patients to perform cardiovascular rehabilitation due to their hemiplegia, or one sided weakness,” Dr. Cuccurullo said. “But as physical medicine physicians, we know how to get people with serious impairment moving. Our study found that, with some modifications, stroke survivors, even those with serious neurologic injury and paralysis, could exercise safely. And we found the benefits in overall survival and health to be substantial.”