Veterans more likely to use cardiac rehabilitation when home-based option available

Veterans hospitalized with ischemic heart disease more often participated in cardiac rehabilitation when a home-based program was available to them, according to a research letter published in JAMA Internal Medicine.

The Veterans Health Administration (VHA) has begun implementing home-based cardiac rehabilitation programs to counter two common causes of underuse, lack of transportation and limited access to programs, David A. Schopfer, MD, MAS, from the department of medicine at the University of California, San Francisco, and the department of medicine at the San Francisco VA Health Care System, and colleagues wrote.

Schopfer and colleagues conducted a prospective cohort study of 99,097 veterans hospitalized for MI, PCI and/or CABG between 2010 and 2015. One VHA facility was offering home-based cardiac rehabilitation at the beginning of the study; that number had increased to 12 by the end of the study.

The researchers compared participation in cardiac rehabilitation across three kinds of facilities: off-site facility-based programs reimbursed by the VHA; off-site or VHA on-site programs; and off-site programs, VHA on-site programs or home-based programs.

Participation rose

During the study period, overall participation in cardiac rehabilitation increased from 8.1% to 13.2% (P < .001), according to the researchers.

In the 12 facilities that implemented home-based programs by the end of the study period, participation in cardiac rehabilitation rose from 6% to 24.6% (P < .001), they wrote.

In the 23 facilities that offered referral to off-site cardiac rehabilitation or conducted on-site cardiac rehabilitation, participation rose during the study from 10.9% to 17.6% (P < .001).

However, in the 52 facilities that only offered referral to off-site cardiac rehabilitation, participation did not change over time (6.4% to 6.6%; P = .63), Schopfer and colleagues wrote.

When counting participation as attendance at a minimum of three cardiac rehabilitation sessions, participation improved over time at facilities offering home-based programs (5.1% to 16.6%; P < .001), facilities that offered referral to off-site cardiac rehabilitation or conducted on-site cardiac rehabilitation (8.3% to 9.6%; P = .01) and facilities offering off-site programs only (5.2% to 6%; P = .02), according to the researchers.

Odds of partic i pating

Compared with those at facilities offering off-site programs only, those at facilities offering off-site, on-site or home-based programs had a fourfold greater likelihood of participating in cardiac rehabilitation (OR = 4.11; 95% CI, 1.43-11.25). Those at facilities offering off-site or on-site programs were also more likely than those at facilities offering off-site programs only to use cardiac rehabilitation (OR = 3.28; 95% CI, 1.56-6.91).

Type of program did not affect the number of weeks of cardiac rehabilitation completed, but patients offered a home-based program were less likely to stop after the first session than those not offered a home-based program (16.8% vs. 20.2%; P < .001).

While there may be bias due to facilities offering home-based programs being likely to be strong advocates for cardiac rehabilitation, “these findings demonstrate that [home-based cardiac rehabilitation] may be an effective tool for increasing [cardiac rehabilitation] among patients who would otherwise decline to participate,” Schopfer and colleagues wrote. – by Erik Swain

Disclosure s : The authors report no relevant financial disclosures.