Home-Based Cardiac Rehabilitation May Decrease Mortality
BACKGROUND:
Cardiac rehabilitation (CR) is recommended following a cardiac event (i.e., myocardial infarction, heart failure, coronary artery bypass surgery). CR focuses on eliminating tobacco use, improving diet, engaging in physical exercise, managing stress, and taking medications that treat high blood pressure or high cholesterol. However, participation in CR – across the United States – remains low. Using data from the Healthy Heart Program, this retrospective cohort study evaluated all Veterans (n=1,120) who were referred to home-based CR (HBCR) at the San Francisco VA Medical Center between August 2013 and December 2018. Those who participated in HBCR (n=490; 44%) received up to nine coaching and motivational interview calls, a workbook and a personal health journal to document vital signs, exercise, and diet for 12 weeks. They also received a blood pressure monitor, a scale and (if desired) a stationary bike. A nurse or exercise physiologist worked one-on-one with patients to create achievable physical activity goals. Veterans also received follow-up phone calls from program staff at 3 and 6 months after program completion and were followed for an average of 4 years after hospitalization. Using VA data, investigators examined patient demographics, comorbid conditions, and vital status. The primary outcome was one-year mortality and the secondary outcome was mortality over the entire study period (4 years) for 630 Veterans who declined to participate and the 490 Veterans who did participate in HBCR.
FINDINGS:
- Veterans who underwent home-based cardiac rehabilitation had 36% lower risk of mortality after 4 median years of follow-up compared to nonparticipants, suggesting that participation in HBCR may benefit patients who cannot attend traditional CR programs.
- Even when home-based cardiac rehabilitation was offered at the time and place of their choosing, only 44% of eligible Veterans chose to participate.
- The majority of Veterans (68%) in this study lived in urban areas and half (50%) were hospitalized for a percutaneous coronary intervention (PCI) before being referred to HBCR.
IMPLICATIONS:
- This is the first observational U.S. study to provide evidence of a survival benefit with home-based cardiac rehabilitation in people with heart disease. These findings are especially relevant given that COVID-19 has caused many CR programs to offer home-based CR as a temporary intervention.
LIMITATIONS:
- Statistical models were used to adjust for differences between groups, but patients who choose to participate in HBCR may differ from those who don’t in ways that affect their mortality risk.
- Because the San Francisco VAMC does not have a center-based CR (CBCR) program, investigators were unable to compare HBCR to CBCR.
AUTHOR/FUNDING INFORMATION:
This study was funded through VA’s Office of Rural Health (ORH) and the Quality Enhancement Research Initiative (QUERI). Dr. Whooley co-leads Measurement Science QUERI and is part of VA San Francisco Health Care.
Krishnamurthi N, Schopfer D, Shen H, Rohrbach G, Elnaggar A, and Whooley M. Association of Home-Based Cardiac Rehabilitation with Lower Mortality in Patients with Cardiovascular Disease: Results from the Veterans Health Administration Healthy Heart Program. Journal of the American Heart Association. March 1, 2023; e025856: online ahead of print.
