Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study

Jos J Kraal, M Elske Van den Akker-Van Marle, Ameen Abu-Hanna, Wim Stut, Niels Peek, Hareld Mc Kemps, Jos J Kraal, M Elske Van den Akker-Van Marle, Ameen Abu-Hanna, Wim Stut, Niels Peek, Hareld Mc Kemps

Abstract

Aim Although cardiac rehabilitation improves physical fitness after a cardiac event, many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time. Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness. Methods and results We randomised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training. Although training adherence was similar between groups, satisfaction was higher in the home-based group ( p = 0.02). Physical fitness improved at discharge ( p < 0.01) and at one-year follow-up ( p < 0.01) in both groups, without differences between groups (home-based p = 0.31 and centre-based p = 0.87). Physical activity levels did not change during the one-year study period (centre-based p = 0.38, home-based p = 0.80). Healthcare costs were statistically non-significantly lower in the home-based group (€437 per patient, 95% confidence interval -562 to 1436, p = 0.39). From a societal perspective, a statistically non-significant difference of €3160 per patient in favour of the home-based group was found (95% confidence interval -460 to 6780, p = 0.09) and the probability that it was more cost-effective varied between 97% and 75% (willingness-to-pay of €0 and €100,000 per quality-adjusted life-years, respectively). Conclusion We found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness, physical activity level or health-related quality of life. However, home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training. We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation.

Keywords: Cardiac rehabilitation; home-based training; physical activity; physical fitness; telemonitoring.

Figures

Figure 1.
Figure 1.
Flow diagram of the study. CR: cardiac rehabilitation.
Figure 2.
Figure 2.
Overview of incremental costs and effects (quality-adjusted life-years (QALYs)) of home-based cardiac rehabilitation (CR) compared with centre-based CR.
Figure 3.
Figure 3.
Cost-effectiveness acceptability curves for home-based (HB) cardiac rehabilitation (CR) compared with centre-based (CB) CR. QALY: quality-adjusted life-year.

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Source: PubMed

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