Association Between Copayments and Attendance in Cardiac Rehabilitation: A Nationwide Analysis From the AACVPR Registry
Author Department
Healthcare Quality; Medicine; Cardiology
Document Type
Article, Peer-reviewed
Publication Date
3-2026
Abstract
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.
Keywords: cardiac rehabilitation; copays; cost barriers; cost sharing; insurance coverage.
Recommended Citation
Thapa S, Naser M, Farah M, Zhang Y, Howard G, Lagu T, Lindenauer PK, Pack QR. Association Between Copayments and Attendance in Cardiac Rehabilitation: A Nationwide Analysis From the AACVPR Registry. J Am Heart Assoc. 2026 Mar 25:e049082. doi: 10.1161/JAHA.125.049082. Epub ahead of print.
PMID
41878870