Association Between Copayments and Attendance in Cardiac Rehabilitation: A Nationwide Analysis From the AACVPR Registry

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Background Improving cardiac rehabilitation (CR) participation is a national priority. This study examines the prevalence and cost of copays and their relationship with CR attendance and dropout. Methods We analyzed the AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation) registry using the AACVPR Data Analytic Center, including patients from 2012 to 2021 with recorded copayment (including 0) while excluding those without this data. The primary outcome was the association between total CR sessions attended and both copay presence and amount, assessed using multivariable models, adjusting for key literature‐based adherence predictors and baseline patient characteristics. Results Among 59 838 patients with copay data, 16 339 (27.3%) had a copay. The median (interquartile range) copay was $24.00 (20, 34). Medicare, Medicaid, private, and Other insurances charged a median (interquartile range) copay of $20.00 (20–25), $3.70 (3, 12), $30.00 (20–40), and $25.00 (20 to 36), respectively. Copays were more common in New York and the Northeast and less common in California and the Midwest. The highest copay amounts were observed in South Dakota, Oklahoma, and Connecticut (>$34.00). In multivariable model, the presence of copay was associated with attendance at 4.9 (95% CI: 4.3 to 5.6, P <0.001) fewer sessions of CR. Every $10 increase in copay was associated with 0.5 (0.4 to 0.6, P <0.001) fewer CR sessions. Copays were cited as the reason for early dropout in 23% of cases. Conclusions Copays for CR were common, costly, and associated with fewer CR sessions. Policymakers should reconsider these policies to promote CR participation.

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