Veterans with Heart Disease More Likely to Participate in Cardiac Rehabilitation (CR) When Home-Based CR Program is Available
Performance measures recommend referral to cardiac rehabilitation (CR) after acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). Lack of transportation and limited access to CR programs were identified as two of the largest barriers to participation. To address this issue, VA started implementing new home-based CR (HBCR) programs. This study examined whether the implementation of new HBCR programs is associated with improved CR participation among Veterans.
This prospective cohort study focused on 99,097 Veterans who were hospitalized for MI, PCI, or CABG at 151 VA healthcare facilities between January 2010 and December 2015. Specifically, investigators compared CR participation across three groups: offsite facility-based CR programs reimbursed by VA (n=49,993), offsite CR or VA onsite CR programs (n=31,974), or offsite or VA onsite or HBCR programs (n=17,130). Participation was defined as engaging in at least one outpatient CR session within 12 months of hospital discharge. Study findings show:
- Veterans hospitalized with ischemic heart disease were more likely to participate in CR when a home-based program was available.
- Implementation of home-based cardiac rehabilitation increased participation from 6% to 25%, and was associated with four-fold greater odds of participation.
- Overall, participation in at least one CR session increased from 8% to 13%.
- No significant difference was found in the number of weeks of CR completed among Veterans offered HBCR versus those not offered HBCR (median 8 vs. 9 weeks). However, Veterans offered HBCR were less likely to drop out after the first session than were those for whom HBCR was not available.
Home-based cardiac rehabilitation may be an effective tool for increasing CR participation among Veterans who would otherwise decline participation, thereby improving patient outcomes.
This study was funded by VA HSR&D's Quality Enhancement Research Initiative (QUERI). Dr. Whooley leads the Measurement Science QUERI, and is Director of Cardiac Rehabilitation at the San Francisco VA Health Care System. Dr. Forman is part of the VA Pittsburgh Healthcare System.
Schopfer D, Krishnamurthi N, Shen H, Duvernoy C, Forman D, and Whooley M. Association of Veterans Health Administration Home-Based Programs with Access to and Participation in Cardiac Rehabilitation. JAMA Internal Medicine. Research Letter. January 22, 2018;epub ahead of print.