Cardiac Rehabilitation in the Home Setting
Objective: The goal of this study was to compare the effectiveness of home-based, transtelephonically monitored cardiac rehabilitation with standard, on-site, supervised cardiac rehabilitation.
Background: Participation in cardiac rehabilitation has been demonstrated to increase exercise capacity, decrease cardiovascular symptoms, improve psychosocial status, and decrease total and cardiovascular mortality rates in patients with coronary heart disease. Because of multiple factors, national overall participation is only at 15% of eligible patients.
Methods: Effects of a 3-month home-based, transtelephonically monitored rehabilitation program (n = 83 patients) with simultaneous voice and electrocardiographic transmission to a centrally located nurse coordinator were compared with effects of a standard on-site rehabilitation program (n = 50 patients). The study design was a multicenter, controlled trial. Primary outcome variables were peak aerobic capacity and quality of life, as measured by the Health Status Questionnaire.
Results: Patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site (18% vs 23%). Quality of life domains of physical functioning, social functioning, physical role limitations, emotional role limitations, bodily pain, and energy/fatigue improved similarly in both groups. There were no circulatory arrests or other major exercise-related medical events in either group. A total of 3100 hours of home exercise were transtelephonically monitored.
Conclusions: Patients with coronary heart disease can effectively participate in home-based, monitored cardiac rehabilitation, with exercise and quality of life improvements comparable to those demonstrated at on-site programs.
It is well-documented that supervised, on-site cardiac rehabilitation for patients with coronary heart disease results in increased exercise capacity, decreased symptoms of angina and dyspnea, improved psychosocial well-being and stress levels, and reduced rates of total and cardiovascular mortality. These benefits can be delivered safely, in appropriately screened patients, with coronary death rates during rehabilitation sessions ranging from 1 death per 116,000 patient hours to 1 death per 784,000 patient hours. However, despite these well-established benefits, delivered in a safe and supportive environment, only 15% of eligible patients actually participate in cardiac rehabilitation programs. Reasons for nonparticipation include lack of geographically available programs, transportation or work constraints, and physician nonreferral.
The concept of home-based cardiac rehabilitation is not new. Studies from the 1980s document the feasibility of home-based rehabilitation in primarily low-risk patients with coronary artery disease. More recent studies have incorporated intensive risk factor modification alongside the home exercise component. Many have advocated the expansion of home-based rehabilitation programs as a solution for the low rates of participation in cardiac rehabilitation programs.
Recent technologic advances allow the use of simultaneous online transtelephonic electrocardiogram (ECG) and voice monitoring during cardiac rehabilitation exercise sessions. In this study, exercise capacity and quality of life outcomes of home-based, transtelephonically monitored rehabilitation were compared with outcomes after on-site rehabilitation. There was no preferential selection of lower risk patients into the home program, and only the highest risk patients were excluded from either program.
Objective: The goal of this study was to compare the effectiveness of home-based, transtelephonically monitored cardiac rehabilitation with standard, on-site, supervised cardiac rehabilitation.
Background: Participation in cardiac rehabilitation has been demonstrated to increase exercise capacity, decrease cardiovascular symptoms, improve psychosocial status, and decrease total and cardiovascular mortality rates in patients with coronary heart disease. Because of multiple factors, national overall participation is only at 15% of eligible patients.
Methods: Effects of a 3-month home-based, transtelephonically monitored rehabilitation program (n = 83 patients) with simultaneous voice and electrocardiographic transmission to a centrally located nurse coordinator were compared with effects of a standard on-site rehabilitation program (n = 50 patients). The study design was a multicenter, controlled trial. Primary outcome variables were peak aerobic capacity and quality of life, as measured by the Health Status Questionnaire.
Results: Patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site (18% vs 23%). Quality of life domains of physical functioning, social functioning, physical role limitations, emotional role limitations, bodily pain, and energy/fatigue improved similarly in both groups. There were no circulatory arrests or other major exercise-related medical events in either group. A total of 3100 hours of home exercise were transtelephonically monitored.
Conclusions: Patients with coronary heart disease can effectively participate in home-based, monitored cardiac rehabilitation, with exercise and quality of life improvements comparable to those demonstrated at on-site programs.
It is well-documented that supervised, on-site cardiac rehabilitation for patients with coronary heart disease results in increased exercise capacity, decreased symptoms of angina and dyspnea, improved psychosocial well-being and stress levels, and reduced rates of total and cardiovascular mortality. These benefits can be delivered safely, in appropriately screened patients, with coronary death rates during rehabilitation sessions ranging from 1 death per 116,000 patient hours to 1 death per 784,000 patient hours. However, despite these well-established benefits, delivered in a safe and supportive environment, only 15% of eligible patients actually participate in cardiac rehabilitation programs. Reasons for nonparticipation include lack of geographically available programs, transportation or work constraints, and physician nonreferral.
The concept of home-based cardiac rehabilitation is not new. Studies from the 1980s document the feasibility of home-based rehabilitation in primarily low-risk patients with coronary artery disease. More recent studies have incorporated intensive risk factor modification alongside the home exercise component. Many have advocated the expansion of home-based rehabilitation programs as a solution for the low rates of participation in cardiac rehabilitation programs.
Recent technologic advances allow the use of simultaneous online transtelephonic electrocardiogram (ECG) and voice monitoring during cardiac rehabilitation exercise sessions. In this study, exercise capacity and quality of life outcomes of home-based, transtelephonically monitored rehabilitation were compared with outcomes after on-site rehabilitation. There was no preferential selection of lower risk patients into the home program, and only the highest risk patients were excluded from either program.