Home-based cardiac rehabilitation may reduce mortality, study finds
An at-home program for recently hospitalized patients included telephone coaching and motivational interviewing sessions, a workbook, a DVD, and a personal health journal, as well as additional equipment as needed, and was associated with a reduction in mortality.
Home-based cardiac rehabilitation was associated with 36% lower risk of mortality compared to no rehabilitation, an observational study found.
To compare mortality rates in home-based cardiac rehabilitation participants versus nonparticipants, researchers evaluated all patients who were referred to and eligible for outpatient cardiac rehabilitation between 2013 and 2018 after hospitalization in a Veterans Health Administration facility in San Francisco. Patients who chose to attend facility-based rehab and those who died within 30 days of hospitalization were excluded. Results were published March 1 by the Journal of the American Heart Association.
Of the 1,120 patients who were referred and eligible, 44% participated in home-based cardiac rehabilitation. Patients who chose to participate in home-based rehab received up to nine telephone coaching and motivational interviewing sessions over 12 weeks, as well as a workbook, DVD, and personal health journal for documenting vital signs, activity, and dietary intake. Participants received additional equipment on an as-needed basis, including resistance bands, a scale, a blood pressure cuff, a pedometer/heart rate monitoring device, an exercise peddler or stationary bike, and a video about diet. A nurse or exercise physiologist assisted the patient in creating achievable goals.
Over the year following index hospitalization, the overall mortality rate was 3%; over the entire study, it was 17%. One-year mortality was 4% (28 of 630) among nonparticipants versus 2% (10of 490) among participants (unadjusted P=0.03; inverse proportional treatment weighting-adjusted P=0.31). The mortality rate during the entire follow-up period was 20% (128 of 630) among nonparticipants versus 12% (57 of 490) among home-based participants (unadjusted P<0.01). Researchers calculated that the hazard ratio for mortality was 0.64 among home-based participants versus nonparticipants (95% CI, 0.45 to 0.90; P=0.01).
The study authors noted that although unmeasured confounding can never be eliminated in an observational study, the findings suggest that home-based programs may benefit patients who cannot attend traditional programs. “Our findings are especially relevant in light of the COVID-19 pandemic, which has caused many CBCR [center-based cardiac rehabilitation] programs to offer HBCR [home-based cardiac rehabilitation] as a temporizing measure,” they wrote. “As CBCR centers reopen, continuing to offer HBCR or hybrid programs to participants may be an innovative and equally effective method to deliver [cardiac rehabilitation] while maintaining social distance requirements.”