1161 — Home-based cardiac rehabilitation improves access to care and exercise capacity among Veterans with coronary heart disease

Lead/Presenter: Mary Whooley,  San Francisco VA
All Authors: Whooley MA (Measurement Science QUERI), Schopfer DW (San Francisco VA), Duvernoy C (Ann Arbor VA) Allsup K (Pittsburgh VA) Forman DE (Pittsburgh VA)

Objectives:
Exercise?based cardiac rehabilitation (CR) reduces mortality after hospitalization for acute myocardial infarction (MI), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). Unfortunately, only 10 percent of eligible Veterans participate in CR because (in part) it is not feasible to attend supervised (facility-based) exercise sessions. To address this quality gap, the VA Office of Rural Health is funding the development of home-based CR programs. We sought to (a) compare time from index event to enrollment among Veterans referred to home-based versus facility-based CR; and (b) evaluate change in exercise capacity among Veterans who completed these programs.

Methods:
We compared number of days from index event (MI, CABG or PCI) to enrollment among patients who were referred to home-based CR (at the San Francisco VA) versus facility?based CR (at the Pittsburgh or Ann Arbor VA facilities) between August 2015 and August 2017. Veterans enrolled in CR were invited to participate in a follow-up study that included a 6-minute walk test (6MWT) at baseline and 3 months after initiating CR. We used analysis of variance to compare 3-month change in 6MWT distance.

Results:
Among 1154 eligible patients referred, 41 percent (231/557) enrolled where home?based CR was offered, and 42 percent (252/597) enrolled where facility-based CR was offered (p = 0.74). Median time from index event to enrollment was shorter in patients referred to home-based versus facility-based CR (20 versus 65 days; p < 0.001). Of the 235 low and moderate-risk Veterans who completed the baseline 6MWT, 179 (76 percent) completed the 3-month examination. Among these, the 86 patients enrolled in home-based CR had greater mean increases in 6MWT distance than the 93 patients enrolled in facility-based CR (95 versus 41 meters gained; p < 0.001). Results were similar after adjustment for demographic variables, indication, comorbid conditions, and number of days from index event to enrollment (96 versus 44 meters gained, p = 0.01).

Implications:
Participants referred to home-based CR had shorter time to enrollment and greater 3-month increases in 6MWT distance than those referred to traditional, facility-based CR.

Impacts:
In selected patients, home-based CR achieves functional gains that are at least similar and possibly even superior to traditional CR.