12-month outcomes for home-based cardiac rehabilitation: Experience from the Veteran Affairs

Abstract: PURPOSE: To examine 12-month maintenance of physical and psychosocial benefits achieved during the veterans affairs (VA) home-based cardiac rehabilitation (HBCR) program. METHODS: Using a retrospective, observational design, data were collected from 16 HBCR VA sites. Analyses included participants with data on enrollment, program completion, and 12-month follow-up. Changes over time were examined using repeated measures ANOVA. Logistic regression was used to examine the patient's primary referral diagnosis for enrollment and baseline AACVPR risk stratification category, to predict cardiac-related hospitalization and emergency department (ED) visits at 12 months. RESULTS: Of the 572 patients who completed the program, 208 patients (36%) had data at all three time points. Most participants were White males with a mean age of 69.5 ± 8.2 years. Approximately half of the included participants (n = 99) were classified as high risk at enrollment. Over 12 months, several significant improvements were found (P ≤.05), including exercise capacity, depression (Patient Health Questionnaire-9 scores and American Association of Cardiovascular and Pulmonary Rehabilitation criteria), self-reported cardiac self-efficacy (understanding of managing heart disease), eating habits (Rate Your Plate, Heart Assessment), weight, diastolic blood pressure, and high-density lipoprotein cholesterol levels. Fourteen percent (n = 30) of participants had one or more cardiac-related ED visits, and 14% (n = 29) of participants had one or more cardiac-related hospitalizations. CONCLUSIONS: Home-based models have been proven to be a safe and effective alternative to on-site programs. Our findings demonstrate maintenance of health benefits at 12 months following a home-based model. Future analysis of the HBCR model is necessary to evaluate maintenance improvements in those participants who did not receive additional follow-up appointments.