Home-Based Cardiac Rehabilitation: A SCIENTIFIC STATEMENT from the AMERICAN ASSOCIATION of CARDIOVASCULAR and PULMONARY REHABILITATION, the AMERICAN HEART ASSOCIATION, and the AMERICAN COLLEGE of CARDIOLOGY

Randal J. Thomas, Alexis L. Beatty, Theresa M. Beckie, LaPrincess Brewer, Todd M. Brown, Daniel E. Forman, Barry A. Franklin, Steven J. Keteyian, Dalane W. Kitzman, Judith G. Regensteiner, Bonnie K. Sanderson, Mary A. Whooley

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR 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.

Original languageEnglish (US)
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
DOIs
StatePublished - Jan 1 2019

Fingerprint

Thoracic Surgery
Exercise
Cardiac Rehabilitation
Minority Groups
Behavior Therapy
Health Behavior
Patient Education
Secondary Prevention
Research
Canada
Myocardial Ischemia
Cardiovascular Diseases
Heart Failure
Organizations
Morbidity
Delivery of Health Care
Mortality
Mentoring
United Kingdom

Keywords

  • behavior therapy
  • cardiac rehabilitation
  • exercise
  • patient education

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Home-Based Cardiac Rehabilitation : A SCIENTIFIC STATEMENT from the AMERICAN ASSOCIATION of CARDIOVASCULAR and PULMONARY REHABILITATION, the AMERICAN HEART ASSOCIATION, and the AMERICAN COLLEGE of CARDIOLOGY. / Thomas, Randal J.; Beatty, Alexis L.; Beckie, Theresa M.; Brewer, LaPrincess; Brown, Todd M.; Forman, Daniel E.; Franklin, Barry A.; Keteyian, Steven J.; Kitzman, Dalane W.; Regensteiner, Judith G.; Sanderson, Bonnie K.; Whooley, Mary A.

In: Journal of Cardiopulmonary Rehabilitation and Prevention, 01.01.2019.

Research output: Contribution to journalArticle

Thomas, Randal J. ; Beatty, Alexis L. ; Beckie, Theresa M. ; Brewer, LaPrincess ; Brown, Todd M. ; Forman, Daniel E. ; Franklin, Barry A. ; Keteyian, Steven J. ; Kitzman, Dalane W. ; Regensteiner, Judith G. ; Sanderson, Bonnie K. ; Whooley, Mary A. / Home-Based Cardiac Rehabilitation : A SCIENTIFIC STATEMENT from the AMERICAN ASSOCIATION of CARDIOVASCULAR and PULMONARY REHABILITATION, the AMERICAN HEART ASSOCIATION, and the AMERICAN COLLEGE of CARDIOLOGY. In: Journal of Cardiopulmonary Rehabilitation and Prevention. 2019.
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abstract = "Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR 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.",
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