Medicare and most other insurers cover cardiac rehabilitation for people with Congestive Heart Failure (CHF) — but only if they have a “compromised ejection fraction.” What is “ejection fraction,” and why is it important?
Types of Congestive Heart Failure
Congestive Heart Failure occurs when the heart’s ability to pump blood to the body has decreased significantly. It is a chronic, long-term condition that worsens over time.
Congestive Heart Failure is usually divided into two types:
Heart Failure with preserved ejection fraction (HF-pEF), in which the heart is able to pump normally, but the ventricles (lower chambers) of the heart are stiffer and thicker than normal, and do not relax enough between beats to fill up normally with blood. Because the ventricles do not contain enough blood, not enough blood is pumped out to the body during heartbeats. HF-pEF is also known as Diastolic Heart Failure.
The risk of HF-pEF increases with age, and it is usually caused by other conditions, such as high blood pressure, diabetes, chronic kidney disease, atrial fibrillation, or Coronary Artery Disease (CAD).
Heart Failure with reduced ejection fraction (HF-rEF), in which the left ventricle (lower left chamber) of the heart is too weak to pump an adequate amount of blood to the body. HF-rEF is also known as Systolic Heart Failure.
People with reduced ejection fraction tend to have more hospitalizations and worse outcomes than those with preserved ejection fraction.
Ejection Fraction is most commonly measured by echocardiogram, although MRIs and nuclear stress tests may also be used. These tests measure the amount of blood being pumped from the left ventricle each time the heart contracts. The results are given as a percentage of how much blood a healthy heart is able to pump. This percentage is known as the Ejection Fraction.
Compromised Ejection Fraction
Although in theory, “normal” blood flow should be 100%, in practice, even if the heart pumps considerably less blood it can still be considered to have a normal ejection fraction. If the heart is able to pump at least 50% of the blood in the left ventricle, the ejection fraction is considered normal. If the heart is able to pump less than 50% of the blood in the left ventricle, the ejection fraction is considered to be reduced or compromised. An ejection fraction of less than 35-40% is considered severely below normal. In cases of severely compromised ejection fraction, there is high risk of cardiac arrest.
For this reason, an ejection fraction of less than 40% often requires more intensive intervention, such as implanting a cardioverter defibrillator (ICD) or, less commonly, having a heart transplant. These interventions are serious enough to require cardiac rehab, and therefore Medicare and other insurers will pay for it.
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