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

• Published in: Journal of the American College of Cardiology Vol. 74; no. 1; pp. 133 - 153
• Main Authors: Thomas, Randal J, Beatty, Alexis L, Beckie, Theresa M, Brewer, LaPrincess C, Brown, Todd M, Forman, Daniel E, Franklin, Barry A, Keteyian, Steven J, Kitzman, Dalane W, Regensteiner, Judith G, Sanderson, Bonnie K, Whooley, Mary A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 09-07-2019
• Subjects: Adults; Behavior modification; Cardiac Rehabilitation - methods; Cardiac Rehabilitation - standards; Cardiology; Cardiovascular disease; Cardiovascular diseases; Clinical trials; Congestive heart failure; Coronary artery disease; Coronary vessels; Counseling; Educational materials; Exercise; Fitness training programs; Health care; Heart surgery; Home Care Services - standards; Hospitals; Humans; Ischemia; Medicaid; Medicare; Minority & ethnic groups; Morbidity; Older people; Participation; Patient education; Patients; Physical fitness; Rehabilitation; Subgroups; Womens health; United Kingdom > UK; United States > US; exercise; behavior therapy; patient education; cardiac rehabilitation; AHA Scientific Statements
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.03.008

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.