3146 — Rural Veterans Prefer Home-Based Cardiac Rehabilitation

Schopfer DW, San Francisco VA Medical Center; Rohrbach G, San Francisco VA Medical Center; Rush KM, San Francisco VA Medical Center; Whooley MA, San Francisco VA Medical Center;

Objectives:
Referral to cardiac rehabilitation (CR) is one of 9 performance measures for patients with ischemic heart disease (IHD), but fewer than 10% of eligible Veterans participate. Home-based CR programs may improve participation in CR, particularly for rural Veterans who do not live near traditional facility-based programs. We sought to compare referral to, participation in, and completion of CR in rural and urban Veterans.

Methods:
In partnership with the VA Office of Rural Health, we established The Healthy Heart Program to increase participation in CR programs and provide home-based CR (as an alternative to facility-based CR programs) for Veterans with IHD. Between August 2013 and October 2014, 406 eligible patients were referred to CR during hospitalization for myocardial infarction, percutaneous or surgical coronary revascularization at the San Francisco VA Medical Center. We used the Rural-Urban Commuting Areas (zip code) system to categorize urban and rural Veterans. We then compared the proportions of urban vs. rural Veterans who were referred to, enrolled in, and completed home-based CR.

Results:
Overall, 49% (65/132) of rural and 46% (127/274) of urban Veterans agreed to enroll in CR. Among patients who agreed to enroll, 159 (83%) chose home-based and 33 (17%) chose center-based CR (p < 0.001). Rural Veterans were more likely than urban Veterans to choose home-based CR (95% vs. 76%; p < 0.001) and less likely to choose center-based CR (5% vs. 24%; p < 0.001). Among the 192 patients who were interested in CR, rural Veterans were more likely than urban Veterans to complete 12 weeks of home-based CR (65% vs. 43%; p = 0.005). Among the 159 patients who enrolled in home-based CR, rates of completion were similar in urban and rural Veterans (68% vs. 57%; p = 0.17).

Implications:
The vast majority of Veterans who were interested in CR chose a home-based over a center-based program. Rural Veterans were more likely to choose home-based CR and to complete CR. We conclude that home-based CR is an effective way of engaging patients, especially for rural Veterans.

Impacts:
Implementation of a home-based CR program within VA provides a viable alternative for Veterans with IHD who are unable or uninterested in participating in traditional facility-based CR.