Cardiovascular Outcomes of Patients Referred to Home Based Cardiac Rehabilitation.
S Hammad Jafri, Tasnim F Imran, Elizabeth Medbury and 5 others
PMID 34801771WHAT IT FOUND
Patients who attended home cardiac rehab had fewer deaths or hospitalizations from 3 to 12 months after referral.
The program bundled exercise, monitoring, education and nurse calls, so the cause is unclear.
Key findings
01The primary composite of death or hospitalization from 3 to 12 months occurred in 30 patients (19.1%) in the HBCR group and 30 patients (30%) in the Non-HBCR group, with adjusted HR 0.56 (CI 0.33-0.95, P = .03).
02All-cause mortality was 6.4% in HBCR patients and 13% in Non-HBCR patients (adjusted HR 0.43, CI 0.18-1.0, P = .05), and all-cause hospitalization was 12.7% versus 21% (adjusted HR 0.53, CI 0.28-1.01, P = .05); cardiovascular hospitalization was not significant.
03In HBCR participants, systolic blood pressure changed from 126 mmHg to 117 mmHg, total cholesterol from 145 mg/dl to 132 mg/dl, and PHQ-9 score from 6 to 5; 6-minute walk distance and Duke activity score did not change significantly.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
Single-center Veterans Affairs study. Most patients were male and white, so results may not apply to women or other ethnic groups. The design was observational and non-randomized, so residual confounding cannot be excluded. Patients who attended HBCR were less likely to smoke, less likely to have had coronary artery bypass grafting and had higher left ventricular ejection fraction at baseline. Patients who attended may have been healthier or more motivated than those who did not. Hospitalizations outside the VA system may have been incompletely captured. The home-based program bundled exercise, monitoring, education and counseling, so the contribution of any single component cannot be separated. No significant improvement in 6-minute walk distance or Duke activity score was seen after HBCR.
Declared interests
No competing interests were declared. The home-based cardiac rehabilitation program is supported by the VA Office of Rural Health.
The easy way to misread this
Do not conclude that home-based cardiac rehabilitation caused the lower death and hospitalization rate. The comparison was observational, patients who attended were selected and had healthier baseline features, and the program bundled exercise, monitoring, education and counseling, so no single component can be separated.