Home-based cardiac rehabilitation (rehab) may be a "reasonable option" for some patients as an alternative to medical center cardiac rehab, according to a joint scientific statement from the ACC, the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation published May 13 in the Journal of the American College of Cardiology.

The statement presents a framework for home-based cardiac rehab programs and identifies the core components, efficacy, strengths, limitations, evidence gaps and research necessary to "guide the future delivery and potential reimbursement of home-based cardiac rehab in the U.S."

"There are significant barriers that prevent patients from getting the cardiac rehabilitation care that they need. And, there aren't enough programs in the U.S. to meet the needs of every patient that would benefit," explains Randal J. Thomas, MD, MS, FACC, chair of the writing group for the statement. "There is an urgent need to find new ways of delivering cardiac rehabilitation programs to patients."

To that end, the writing group reviewed studies looking at home-based cardiac rehab vs. center-based cardiac rehab "to assess the comparative effectiveness and potential benefits of home-based cardiac rehab and to explore implementation strategies."

According to the statement, the core components of home-based cardiac rehab interventions are exercise training to target physical activity, dietary education to target healthy eating, medication management to target medication adherence, tobacco counseling to target smoking cessation and psychosocial intervention to target stress management.

The authors conclude that "although the science behind home-based cardiac rehab is relatively new and less developed, its findings are generally consistent with those reported for center-based cardiac rehab."

They add that moving forward, "a lack of reimbursement by most third-party payers represents a challenge to home-based cardiac rehab implementation." In addition, "additional safety data are needed … particularly in higher-risk groups."

"As more evidence accumulates to support home-based cardiac rehab and the technology advances to make this more feasible, we need to work together with policymakers to find ways for these services to be covered," notes Thomas.

Keywords: Behavior Therapy, Costs and Cost Analysis, Diet, Education, Medical, Exercise, Functional Residual Capacity, Life Style, Risk Reduction Behavior, Drug Therapy, Motor Activity, Secondary Prevention, Primary Prevention, Quality of Life, Referral and Consultation, Insurance, Health, Reimbursement, Risk Factors, Safety, Smoking, Tobacco, Body Weight Changes

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