Home as good as hospital for cardiac rehab

NEW YORK (Reuters Health) - Home-based rehabilitation is no worse than hospital-based programs for helping patients get better after a heart attack or surgery to clear blocked heart arteries, and may be more accessible for patients, research from the UK shows.

"Although this study was not designed to show equivalence, the provision of a home-based service alongside the hospital services would provide choice for patients and might improve uptake and adherence in patients who are not willing or able to attend a hospital," Dr. Kate Jolly of the University of Birmingham and her colleagues wrote in the January 2009 issue of the journal Heart.

The risk of death is lower among heart patients who participate in exercise-based rehab, but most patients do not complete these programs. Women, older people, and minorities are even less likely to enter these programs and complete them.

To investigate whether offering patients the chance to do rehab at home might improve adherence, the researchers randomly assigned 525 patients living in England's West Midlands region to a home or traditional hospital-based rehab program. Most patients were from the inner city. The hospital programs, offered at four different centers, were from 8 to 12 weeks long, and began 4 to 8 weeks after a patient's heart attack or revascularization surgery. The home programs included visits from rehab nurses at 10 days, 6 weeks and 12 weeks after discharge from the hospital and a telephone contact 3 weeks after discharge, as well as additional visits if the nurse thought them necessary.

Both programs were based on the Heart Manual developed by NHS Lothian, the umbrella organization for National Health Services' programs in Scotland's Lothian region. The manual recommends patients gradually increase their activity until they are doing at least 15 minutes of moderate intensity exercise every day.

Among patients in the home-based group, 96 percent had at least 5 contacts with rehab nurses, in person or by phone, while just 56 percent of the hospital-based program participants attended at least 5 classes. But at 1 year, the researchers found no clinically significant differences in blood pressure, cholesterol levels, mental health, smoking cessation or exercise ability between the two groups.

While the home program was more expensive than the hospital program, the cost difference disappeared once the researchers took travel expenses and other costs to the patient into account.

"Given the low uptake and adherence to hospital-based cardiac rehabilitation, increased availability of home-based cardiac rehabilitation might help improve uptake and adherence," the researchers conclude.

SOURCE: Heart, January 2009.