Home-based cardiac rehab boosts participation among veterans

Veterans Health Administration (VHA) facilities that implemented home-based cardiac rehabilitation (HBCR) programs saw a four-fold increase in participation over a six-year period, according to a research letter published Jan. 22 in JAMA Internal Medicine.

Cardiac rehab is recommended for patients following MI, PCI and coronary artery bypass graft (CABG) surgery but is widely underused. Previous research has identified lack of transportation and limited access to rehabilitation programs as major barriers to participation, prompting the VHA to implement HBCR programs.

To gauge their effectiveness, lead researcher David W. Schopfer, MD, MAS, and colleagues studied participation rates of 99,097 patients hospitalized for ischemic heart disease at 87 VHA facilities from 2010 through 2015.

Overall, cardiac rehabilitation rates—defined as attending at least one session—increased from 8.1 percent in 2010 to 13.2 percent in 2015. The jump was largest for the 12 facilities that implemented HBCR programs, from 6 to 24.6 percent. Facilities that offered referral to either onsite or offsite programs saw an increase from 10.9 to 17.6 percent, while those that offered referral to only offsite cardiac rehab didn’t see a significant increase (6.4 to 6.6 percent).

The researchers also noted veterans offered HBCR were the least likely to drop out after the first session and the most likely to attend at least three sessions.

“We recognize that results may be biased because facilities that developed HBCR programs were likely to be stronger proponents of (cardiac rehabilitation), and overall CR participation remained low,” Schopfer et al. wrote. “Nonetheless, these findings demonstrate that HBCR may be an effective tool for increasing CR participation among patients who would otherwise decline to participate.”