Scientific Statement on Home-Based Cardiac Rehabilitation

Authors:
Thomas RJ, Beatty AL, Beckie TM, et al.
Citation:
Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 2019;May 13:[Epub ahead of print].

The following are key points to remember from this Scientific Statement on home-based cardiac rehabilitation (CR):

  1. CR is an evidence-based intervention that utilizes patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with established cardiovascular disease.
  2. However, CR programs are significantly underused, with only a minority of eligible patients participating in CR in the United States. This is despite the fact that CR referral is an American College of Cardiology/American Heart Association Class I recommendation after myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, stable angina, symptomatic peripheral arterial disease, heart valve surgery, cardiac transplantation, and chronic heart failure with reduced ejection fraction.
  3. One potential strategy to improve participation and utilization of CR is home-based CR (HBCR).
  4. In contrast to center-based CR (CBCR) services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting.
  5. Theoretically, HBCR can help improve delivery of CR to eligible patients by overcoming common barriers that impede a patient’s participation in CBCR, including transportation challenges, competing time demands, and the lack of CBCR near a patient’s home.
  6. The purpose of this Scientific Statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States.
  7. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and CBCR may achieve similar improvements in clinical outcomes.
  8. It should be noted that although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups.
  9. Based on available data albeit limited, it appears that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional CBCR program.
  10. There is a need to develop, use, and implement evidence-based hybrid approaches to CR that combine the positive and complementary aspects of both CBCR and HBCR to personalize and optimize CR services for each patient and to promote long-term adherence and favorable behavioral change.

Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise, Smoking

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


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