乌鸦传媒

When home-based cardiac rehabilitation programs are available, patients are more likely to participate in them after being hospitalized for ischemic heart disease, according to Veterans Health Administration (VHA) data.

Overall, the 2010-2015 period saw participation -- defined as patients going to at least one outpatient cardiac rehab session within 12 months of discharge -- go up (P<0.001), according to a research letter by David Schopfer, MD, MAS, of the University of California San Francisco, and colleagues, that was published online in JAMA Internal Medicine.

Yet not all facilities saw increases to the same extent:

• The 12 facilities offering home-based cardiac rehabilitation programs (on top of offsite cardiac rehab and VHA onsite cardiac rehab) had participation rise from 6.0% to 24.6% (P<0.001)
• The 23 facilities that offered referral to offsite cardiac rehab or VHA onsite cardiac rehab saw participation increase from 10.9% to 17.6% (P<0.001)
• The 52 facilities that only referred to offsite cardiac rehabilitation had no change in participation (6.4% to 6.6%, P=0.63)

Compared with an offsite referral-only facility, a site with all three cardiac rehabilitation programs available had patient participation improve fourfold (adjusted OR 4.11, 95% CI 1.43-11.85), and one that offers offsite referrals or VHA onsite rehabilitation had a threefold boost (adjusted OR 3.28, 95% CI 1.56-6.91).

Moreover, patients offered home-based programs were less likely to drop out after the first rehabilitation session (16.8% versus 20.2%, P<0.001).

"In summary, veterans hospitalized with ischemic heart disease were more likely to participate in cardiac rehabilitation when a home-based program was available," the researchers wrote. "We recognize that results may be biased because facilities that developed home-based cardiac rehabilitation programs were likely to be stronger proponents of cardiac rehabilitation, and overall cardiac rehabilitation participation remained low.

"Nonetheless, these findings demonstrate that home-based cardiac rehabilitation may be an effective tool for increasing cardiac rehabilitation participation among patients who would otherwise decline to participate."

The prospective cohort study of 151 VHA facilities included 99,097 patients hospitalized for myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting.

From 2010 to 2015, the number of facilities offering home-based cardiac rehabilitation programs increased from one to 12. A sensitivity analysis counting only those who attended sessions at least three times within a year of discharge saw increased participation across all facilities during this time, Schopfer et al noted.

Comment