Fewer hospitalizations after virtual vs. center-based cardiac rehab
Click Here to Manage Email Alerts
A cohort of socioeconomically diverse patients who participated in virtual cardiac rehabilitation were less likely to be hospitalized at 12 months compared with those who participated in center-based rehab, researchers reported.
“In 2018, Kaiser Permanente Southern California launched an innovative digital virtual cardiac rehab program, deliberately designed to increase cardiac rehab participation among all eligible patients with CVD,” Chileshe Nkonde-Price, MD, MS, FACC, cardiologist with Kaiser Permanente Southern California, clinician investigator with the Kaiser Permanente Southern California department of research and evaluation, and assistant professor in the department of clinical science at the Kaiser Permanente Bernard J. Tyson School of Medicine, told Healio. “This was a broad and ambitious goal predating the COVID-19 pandemic that sought to address the well-known fact that although cardiac rehabilitation is recommended and highly effective for improving health after a cardiac event, it remains significantly underutilized. Patients who previously did not have access to cardiac rehabilitation were given the opportunity to heal and recover in their homes. It created a new normal where ongoing virtual digital cardiac care became our standard of care after you left the hospital.”
Assessing diverse cohort
In a retrospective study, Nkonde-Price and colleagues analyzed data from 2,556 patients in the Kaiser Permanente Southern California integrated health care system who participated in at least one cardiac rehab session from April 2018 to April 2019, with follow-up through April 2020. The mean age of patients was 67 years; 28.5% were women and 55.5% were white; 46.8% had a Charlson Comorbidity Index of 4 or more.
“We were delighted to find that our study included the largest group of virtual cardiac rehab patients ever studied,” Nkonde-Price told Healio. “Nearly half (45%) were working age — the age group that typically finds it difficult to participate in the traditional center-based cardiac rehab program — and more than half were older patients, where there is high burden of CVD. Nearly half (45.5%) of participants were from historically marginalized communities, and we even included a small percentage of patients who did not speak English as their primary language.”
The primary outcome was 12-month all-cause hospitalization. Secondary outcomes included all-cause hospitalizations at 30 and 90 days; 30-day, 90-day and 12-month CV hospitalizations; and medication adherence and CV risk factor control at 12 months.
The findings were published in JAMA Network Open.
Within the cohort, 48.5% received home-based cardiac rehab and 51.5% received center-based rehab.
Improvement in hospitalization risk
Using inverse probability of treatment weighting, researchers found that patients who received home-based cardiac rehab had 21% lower odds of hospitalization at 12 months compared with those who attended center-based rehab (OR = 0.79; 95% CI, 0.64-0.97). Home-based participants and center-based participants had similar odds of adherence to beta-blockers (OR = 1.18; 95% CI, 0.98-1.42) and statins (OR = 1.02; 95% CI, 0.84-1.25), as well as similar BP control (OR = 0.98; 95% CI, 0.81-1.17), LDL levels (OR = 0.98; 95% CI, 0.81-1.2) and HbA1c levels (OR = 0.98; 95% CI, 0.82-1.18).
“For the first time, we have shown that virtual cardiac rehabilitation outperforms center-based rehabilitation,” Nkonde-Price told Healio. “Specifically, in a sociodemographically diverse population of adults that included medically complex patients, we found that if you experience a cardiac event and then participate in virtual cardiac rehabilitation, you are 21% less likely to be hospitalized in the 12 months after your cardiac rehab. That is remarkable.”
Nkonde-Price said researchers want to follow patients over time to examine longer-term outcomes and assess the optimal length of cardiac rehabilitation.
“We can ask some important questions, like does participating in virtual cardiac rehabilitation change your trajectory long term?” Nkonde-Price said. “We also need to look at the research questions that will be important for scaling the program. Are there other cardiac patients who can benefit from this program? As we advance the science of cardiovascular medicine, we create new communities of patients, such as patients with implantable cardiac devices or those with congenital heart disease.”
Collapse
Read more about
Click Here to Manage Email Alerts