For patients who need cardiac rehabilitation (CR) but have trouble getting to a clinic that offers it, home-based, medically supervised CR may be an alternative, according to a joint scientific statement from the American Heart Association (AHA), American College of Cardiology (ACC), and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).
The scientific statement on home-based CR was published May 13 in Circulation, the Journal of the American College of Cardiology , and published May 10 in the Journal of Cardiopulmonary Rehabilitation and Prevention.
Traditional center-based CR programs reduce morbidity and mortality in adults with ischemic heart disease, heart failure, or cardiac surgery, but are woefully underused, with only a minority of eligible patients participating in CR in the United States, the researchers say.
“There are significant barriers that prevent patients from getting the cardiac rehabilitation care that they need. And there aren’t enough programs in the United States to meet the needs of every patient who would benefit,” Randal J. Thomas, MD, chair of the writing group and medical director of the cardiac rehabilitation program, Mayo Clinic in Rochester, Minnesota, said in a news release.
Home-based CR “may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program,” the writing group concludes.
Much More Than Advice to Exercise
The scientific statement provides a framework for home-based CR programs to help ensure patients receive standardized, evidence-based care.
Core components of home-based CR include systematic, comprehensive, supervised, and personalized services that focus on medical evaluation, prescribed exercise, cardiovascular risk-factor modification, patient education, and behavioral counseling.
A home-based CR program is much more than advising a patient to exercise at home, Thomas said. For patients with stable heart disease, home-based CR is administered and monitored in the same way and by the same healthcare team as clinic-based CR. “The difference is that supervision and coaching are done remotely, using smartphones and other technology,” said Thomas.
Randomized trials have generated “low- to moderate-strength” evidence that home-based CR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes, the writing group notes. And although home-based CR holds promise in expanding the use of CR to eligible patients, “additional research and demonstration projects are needed to clarify, strengthen, and extend” the evidence base for home-based CR for “key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups,” they say.
“The vast majority of healthcare insurance providers do not cover home-based cardiac rehabilitation,” Thomas told theheart.org | Medscape Cardiology. “The reason for this is unclear but probably has to do with the desire to have more evidence about its benefits and more direction about its components.”
“We hope that this scientific statement helps to clarify the evidence about the benefits of home-based cardiac rehabilitation, and also helps to clarify the components and processes that should be in place for home-based programs,” said Thomas.
“In these ways, we are hoping that the paper will be a positive influence for progress toward more coverage options for home-based cardiac rehabilitation. Medicare/CMS is moving toward more options for reimbursing virtual care and it is hoped that this trend will grow and make it more likely that home-based cardiac rehabilitation will be covered in the near future,” said Thomas.
This research received no commercial funding. Thomas has no relevant disclosures. A complete list of disclosures for the writing group is provided with the original article.