Is home-based rehab effective?

There are numerous studies and real-world implementations that have demonstrated the efficacy of both home-based and hybrid cardiac rehab (CR). When investigating these programs, studies often compare outcomes of patients in a home-based CR intervention group to control groups of patients in either usual care or facility-based CR. Since home-based or hybrid CR is often one of the only means to provide rehab to the ~80% of patients that do not participate in traditional CR [1], this makes the usual care (no rehab) group a particularly relevant comparison group. When compared to usual care, studies have shown home-based CR offers significant improvements in mortality rates, functional capacity, health-related quality of life, hospital readmission rates, and clinical measures like blood pressure, cholesterol, depression, and anxiety. When compared to traditional onsite CR, home-based CR offers equivalent or near equivalent outcomes for improvements in exercise capacity, clinical measures like blood pressure & cholesterol, and health-related quality of life.

What is the evidence?

A 2019 scientific statement published by the AHA, ACC, and AACVPR analyzed 23 studies that compared outcomes of patients in home-based vs onsite CR [2]. Researchers found that patients in the home-based programs experienced equivalent or near equivalent improvements to patients in onsite rehab in one year mortality, exercise capacity, health related quality of life, and modifiable risk factors like weight, blood pressure, cholesterol, and tobacco cessation.

In one meta-analysis of twelve studies (1938 participants), researchers found that there was no difference between home-based CR and onsite CR in mortality risk ratio, cardiac events, exercise capacity, systolic blood pressure, diastolic blood pressure, total cholesterol, HDL-cholesterol, LDL-cholesterol, smoking cessation, or health-related quality of life [3].

Another meta analysis included 18 trials that compared home-based CR to usual care and 6 trials that compared home-based CR to onsite rehab [4]. In the studies which compared home-based cardiac rehab to usual care, researchers found that home-based CR resulted in improvements in systolic blood pressure, exercise capacity, total cholesterol, anxiety and depression, and a reduced relative risk of being a smoker at follow-up. In the studies that compared home-based to onsite CR, researchers found no significant differences in exercise capacity, systolic blood pressure and total cholesterol.

Yet another meta analysis published in the Journal of the American Heart Association analyzed 31 randomized control trials (1791 patients) that compared home-based and hybrid CR to usual care and traditional CR for patients with heart failure [5]. Researchers found that patients in home-based and hybrid CR had higher peak oxygen uptake and health related quality of life compared to patients in usual care. Researchers also found that patients in home-based cardiac rehab demonstrated similar improvements in functional capacity to onsite CR.

A real-world implementation of home-based CR at Kaiser Permanente in Southern California (2362 patients) resulted in a 74% improvement in program completion, and heart failure related readmission rates of less than 2% [6].

Lastly, phas3 conducted a real-world implementation with our own platform that resulted in significant blood pressure reduction, weight loss, and readmission avoidance. Download our case study here!

Conclusion

Given this overwhelming evidence, the data is clear - home-based and hybrid cardiac rehab, when delivered to the appropriate patient population, are an effective alternative to the facility-based program. Contact us to learn more about how you can get a home-based or hybrid program started at your facility!