Effects of Home-Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease

David W Schopfer, Mary A Whooley, Kelly Allsup, Mark Pabst, Hui Shen, Gary Tarasovsky, Claire S Duvernoy, Daniel E Forman, David W Schopfer, Mary A Whooley, Kelly Allsup, Mark Pabst, Hui Shen, Gary Tarasovsky, Claire S Duvernoy, Daniel E Forman

Abstract

Background Cardiac rehabilitation is an established performance measure for adults with ischemic heart disease, but patient participation is remarkably low. Home-based cardiac rehabilitation (HBCR) may be more practical and feasible, but evidence regarding its efficacy is limited. We sought to compare the effects of HBCR versus facility-based cardiac rehabilitation (FBCR) on functional status in patients with ischemic heart disease. Methods and Results This was a pragmatic trial of 237 selected patients with a recent ischemic heart disease event, who enrolled in HBCR or FBCR between August 2015 and September 2017. The primary outcome was 3-month change in distance completed on a 6-minute walk test. Secondary outcomes included rehospitalization as well as patient-reported physical activity, quality of life, and self-efficacy. Characteristics of the 116 patients enrolled in FBCR and 121 enrolled in HBCR were similar, except the mean time from index event to enrollment was shorter for HBCR (25 versus 77 days; P<0.001). As compared with patients undergoing FBCR, those in HBCR achieved greater 3-month gains in 6-minute walk test distance (+95 versus +41 m; P<0.001). After adjusting for demographics, comorbid conditions, and indication, the mean change in 6-minute walk test distance remained significantly greater for patients enrolled in HBCR (+101 versus +40 m; P<0.001). HBCR participants reported greater improvements in quality of life and physical activity but less improvement in exercise self-efficacy. There were no deaths or cardiovascular hospitalizations. Conclusions Patients enrolled in HBCR achieved greater 3-month functional gains than those enrolled in FBCR. Our data suggest that HBCR may safely derive equivalent benefits in exercise capacity and overall program efficacy in selected patients. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02105246.

Keywords: cardiac rehabilitation; exercise; outcomes; telemedicine.

Conflict of interest statement

None.

Figures

Figure 1. Overview of participant flow in…
Figure 1. Overview of participant flow in study.
6MWT indicates 6‐minute walk test; CABG, coronary artery bypass graft; CR, cardiac rehabilitation; FBCR, facility‐based cardiac rehabilitation; HBCR, home‐based cardiac rehabilitation; MI, myocardial infarction; PCI, percutaneous coronary intervention; and VA, Veteran's Administration.
Figure 2. 6MWT distance at baseline and…
Figure 2. 6MWT distance at baseline and 3 months after enrollment.
6MWT indicates 6‐minute walk test; FBCR, facility‐based cardiac rehabilitation; and HBCR, home‐based cardiac rehabilitation.

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