Home-based cardiac rehab programs may be an effective tool for increasing cardiac rehab participation among patients hospitalized with ischemic heart disease (IHD), according to a research letter published Jan. 22 in JAMA Internal Medicine.

David W. Schopfer, MD, MAS, et al., conducted a six-year study to compare cardiac rehab participation in 99,097 patients hospitalized for IHD across three groups of facilities: off-site facility-based cardiac rehab programs reimbursed by the Veterans Health Administration (VHA); either off-site cardiac rehab or VHA on-site cardiac rehab programs; or off-site cardiac rehab, VHA on-site cardiac rehab or home-based cardiac rehab programs. Participation was defined as partaking in at least one outpatient cardiac rehab session within 12 months after the patient's discharge date.

Results showed that participation increased from 6.0 percent (14 out of 234 patients) to 24.6 percent (724 out of 2,941 patients) at the 12 facilities that implemented home-based cardiac rehab programs, and 10.9 percent (815 out of 7,463 patients) to 17.6 percent (928 out of 5,266 patients) at the 23 facilities that offered referral to off-site cardiac rehab or VHA on-site cardiac rehab.

There was no obvious change in cardiac rehab participation at the 52 facilities that offered referral to off-site cardiac rehab only (from 6.4 percent [752 out of 11,771 patients] to 6.6 percent [561 out of 8,504 patients]).

Furthermore, in a sensitivity analysis that required three or more cardiac rehab sessions, participation increased from 5.1 percent (12 out of 234 patients) to 16.6 percent (489 of 2,941 patients) at facilities that offered home-based cardiac rehab, 8.3 percent (621 out of 7,463 patients) to 9.6 percent (504 out of 5,266 patients) at facilities that offered off-site or VHA on-site cardiac rehab, and 5.2 percent (615 out of 11,771 patients) to 6.0 percent (511 out of 8,504 patients) at facilities that offered off-site cardiac rehab only.

The authors also found that patients offered home-based cardiac rehab were less likely to drop out after the first session than those for whom home-based cardiac rehab was not available (423 [16.8 percent] vs. 1,741 [20.2 percent]).

"We recognize that results may be biased because facilities that developed home-based cardiac rehab programs were likely to be stronger proponents of cardiac rehab, and overall cardiac rehab participation remained low," the authors concluded. "Nonetheless, these findings demonstrate that home-based cardiac rehab may be an effective tool for increasing cardiac rehab participation among patients who would otherwise decline to participate."

Keywords: Veterans Health, Outpatients, United States Department of Veterans Affairs, Myocardial Ischemia, Veterans, Referral and Consultation

< Back to Listings