Home-based heart rehab may help patients who can't get to clinics

(Reuters Health) - Some heart attack survivors may benefit from supervised home-based cardiac rehabilitation programs when hospital-based rehab isn’t an option, U.S. doctors say.

Medically supervised rehab programs focused on things like stress reduction, exercise and heart healthy living have long been linked to better survival odds, fewer hospitalizations, and improved quality of life after a heart attack or cardiac procedure. But most patients don’t start rehab or stick with it as long as they should because of barriers like a lack of insurance or the inconvenience of needing to travel and take time off work every time they go to rehab at a hospital.

For the four in five patients who currently don’t do recommended cardiac rehab, home-based programs may be a viable alternative, according to a scientific statement published today by the American Heart Association, the American College of Cardiology, and the American Association of Cardiovascular and Pulmonary Rehabilitation.

“Patients who experience a cardiac event (such as a heart attack or heart surgery), should participate in a cardiac rehabilitation program,” said lead author of the statement Dr. Randal Thomas, medical director of the cardiac rehab program at the Mayo Clinic in Rochester, Minnesota.

“Such programs help patients recover better, feel healthier, and live longer,” Thomas said by email. “Patients who are not able to participate in a center-based cardiac rehabilitation program due to distance, cost, or other barriers, should discuss with their healthcare provider the possibility of participating in a home-based cardiac rehabilitation program.”

Traditional cardiac rehabilitation programs are provided in a medical center and are implemented by a team of physicians, nurses, psychologists, registered dieticians and other professionals.

They help patients recover from heart attacks, bypass surgery, angioplasty, heart failure and other conditions through a program of exercise training, nutrition and psychological counseling tailored to each individual’s needs.

A successful home-based cardiac rehab program would still be supervised by clinicians, but help cut down on hospital visits. It might include customized workout programs or eating plans and involve regular check-ins by phone to make sure patients stay on track.

For stable and low-risk patients, some research already suggests that home-based rehab may work as well as hospital based programs, according to the statement published in Circulation.

What isn’t as clear is how home-based care compares with hospital-based programs for higher-risk cardiac patients, the elderly, women and some understudied minority groups.

And much of the research suggesting home-based rehab works as well as hospital programs hasn’t followed patients beyond one year, said Dr. Hani Jneid, director of interventional cardiology at the Michael DeBakey VA Medical Center and Baylor College of Medicine in Houston.

“Therefore, it is best to reserve home-based cardiac rehab to those at low-or-moderate risk who are unable to receive center-based cardiac rehab for a variety of reasons,” Jneid, who wasn’t involved in the statement, said by email.

Still, there’s so much room for improvement in cardiac rehab participation rates that even some home-based programs could be a big benefit for patients, said Dr. Chip Lavie, of the Ochsner Clinical School-University of Queensland School of Medicine in Australia.

“It is not realistic to get even close to 100 percent attendance, but getting 30 to 50 percent attendance would be really dramatic improvements,” Lavie, who wasn’t involved in the study, said by email. “Certainly, cardiac rehab needs to be re-branded and re-invigorated in the 21st century.”

SOURCE: Circulation, online May 13, 2019.