Disability Burden after Myocardial Infarction: A Population-based Study of Medicare Beneficiaries who used Post-acute Care Services

After myocardial infarction (MI), 50% of older adults use post-acute care (PAC) primarily for recovery from MI-associated disability. There is limited information on disability levels from a national sample. This research described levels of disability and PAC use (home health care (HHC), skilled nursing facilities (SNF), and inpatient rehabilitation facilities (IRF)) in older adults after MI.

This retrospective study used clinical and administrative data from the Chronic Conditions Warehouse of Medicare Beneficiaries (n=63,127) who were discharged to PAC after MI in 2008. Descriptive statistics and multivariable regression were used.  

Overall, Beneficiaries were 58% female and 89% white, with a mean age of 80 (standard deviation=6.3) and 25% were dual-eligible. Discharge destination included 47% discharged to SNF, 45% to HHC, and 8% to IRF. Those discharged to SNF were largely female (63%), older (82 years, SD=5.9), and more likely (79%) to have been treated medically for MI. The greatest proportions of disability were reported in those discharged to SNF (71% were dependent, 21% needed assistance) and IRF (67% were dependent, 28% needed assistance) compared to HHC (17% were dependent, 18% needed assistance, (p<0.001)). Average length of stay was 13 (SD=7) days in IRF and 42 (SD=58) days in SNF (p<0.001) and was associated with disability (p<0.001).

After MI, older adults have substantial disability necessitating PAC use. Medicare does not reimburse for cardiac rehabilitation interventions delivered in PAC. Due to high usage of PAC by cardiac patients, targeted interventions may be necessary to improve outcomes but further research is needed.