Home-based cardiac rehabilitation was developed as an alternative to hospital-based cardiac rehabilitation, which is known to improve health outcomes in patients who have cardiovascular disease (CVD). It's hoped that home-based cardiac rehabilitation will increase participation among eligible patients, but it hasn't been widely studied in demographically diverse populations and in patients who are at higher risk (those who have multiple comorbidities). In a retrospective observational cohort study, researchers compared hospitalizations, medication adherence, and CVD risk factor control in a large, demographically diverse population that included higher risk, medically complex patients who participated in home-based or center-based cardiac rehabilitation in a large integrated health care system.
Patients were eligible for the study if they experienced more than one of the following events within 30 days of their first cardiac rehabilitation session: acute myocardial infarction, stable angina, elective percutaneous coronary intervention, chronic heart failure, or cardiothoracic surgical treatment. The home-based cardiac rehabilitation program is a technology-enabled, eight-week program consisting of unsupervised exercise sessions, weekly calls from a cardiac rehabilitation nurse, and health education. Of the 2,556 patients who participated in cardiac rehabilitation (mean age, 66.7 years; 754 women; 1,196 with a Charlson Comorbidity Index of 4 or higher), 1,241 received home-based cardiac rehabilitation and 1,315 received center-based cardiac rehabilitation.
During 12-month follow-up, patients who participated in the home-based program had fewer all-cause hospitalizations than those in the center-based program (14.8% versus 18.1%). There were no statistically significant differences between the two groups in 30- or 90-day all-cause or CVD hospitalization; adherence to [beta]-blockers or statins; or control of blood pressure, low-density lipoprotein cholesterol, or glycated hemoglobin.
The authors point out that the treating cardiologist had sole discretion to refer patients to home- or center-based cardiac rehabilitation, so there may have been referral bias that affected outcomes. Also, the researchers note, they were unable to determine if the amount of cardiac rehabilitation is independently associated with outcomes.