Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease
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 compa...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.016456 |
| _version_ | 1818314825239887872 |
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| author | David W. Schopfer Mary A. Whooley Kelly Allsup Mark Pabst Hui Shen Gary Tarasovsky Claire S. Duvernoy Daniel E. Forman |
| author_facet | David W. Schopfer Mary A. Whooley Kelly Allsup Mark Pabst Hui Shen Gary Tarasovsky Claire S. Duvernoy Daniel E. Forman |
| author_sort | David W. Schopfer |
| collection | DOAJ |
| description | 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.clinicaltrials.gov; Unique identifier: NCT02105246. |
| first_indexed | 2024-12-13T08:55:47Z |
| format | Article |
| id | doaj.art-15d02887df2d4f98ae7c0916290af42c |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:55:47Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-15d02887df2d4f98ae7c0916290af42c2022-12-21T23:53:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-10-0191910.1161/JAHA.120.016456Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart DiseaseDavid W. Schopfer0Mary A. Whooley1Kelly Allsup2Mark Pabst3Hui Shen4Gary Tarasovsky5Claire S. Duvernoy6Daniel E. Forman7Department of Medicine University of California, San Francisco CADepartment of Medicine University of California, San Francisco CADepartment of Medicine VA Pittsburgh Healthcare System Pittsburgh PADepartment of Medicine University of California, San Francisco CADepartment of Medicine University of California, San Francisco CADepartment of Medicine San Francisco VA Health Care System San Francisco CADivision of Cardiology Department of Medicine University of Michigan Ann Arbor MIDepartment of Medicine VA Pittsburgh Healthcare System Pittsburgh PABackground 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.clinicaltrials.gov; Unique identifier: NCT02105246.https://www.ahajournals.org/doi/10.1161/JAHA.120.016456cardiac rehabilitationexerciseoutcomestelemedicine |
| spellingShingle | David W. Schopfer Mary A. Whooley Kelly Allsup Mark Pabst Hui Shen Gary Tarasovsky Claire S. Duvernoy Daniel E. Forman Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac rehabilitation exercise outcomes telemedicine |
| title | Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease |
| title_full | Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease |
| title_fullStr | Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease |
| title_full_unstemmed | Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease |
| title_short | Effects of Home‐Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease |
| title_sort | effects of home based cardiac rehabilitation on time to enrollment and functional status in patients with ischemic heart disease |
| topic | cardiac rehabilitation exercise outcomes telemedicine |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.016456 |
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