Home-Based Cardiac Rehab Matches Center-Based Care

TOPLINE:

A home-based cardiac rehabilitation (CR) program has shown similar improvements in fitness, functional capacity, and quality of life as center-based programs in optimally treated patients with heart failure (HF), with both groups demonstrating comparable exercise adherence. This supports home-based rehab as an effective alternative.

METHODOLOGY:

• Researchers conducted a noninferiority trial from 2019 to 2022 to evaluate whether a home-based CR program was as effective as a center-based program in improving outcomes for patients with HF.
• They enrolled 120 patients diagnosed with HF (mean age, 62 years; 66% men) with preserved or reduced ejection fraction (mean left ventricular ejection fraction, 36%) who were clinically stable and had been receiving optimal medical treatment for at least 6 weeks.
• The patients were randomly allocated to the 12-week center-based (n = 45) or home-based (n = 75) CR programs. The center-based group received 24 supervised exercise sessions at the hospital’s CR unit, while the home-based group received 4-5 supervised sessions followed by 20 sessions at home with remote monitoring.
• Patients in both the programs received counseling for lifestyle changes, as well as nutritional and psychological support for 12 weeks.
• The primary endpoint was the change in peak oxygen uptake at 12 weeks, while secondary endpoints included health-related quality of life (HRQOL), disease-related biomarkers, 6-minute walking distance, and physical fitness.

TAKEAWAY:

• By the end of the program, both home- and center-based groups showed an increase in peak oxygen uptake, but the improvement was significant only in the home-based group (1.40 mL/kg/min; P
• Both groups showed similar improvements in HRQOL, cardiopulmonary exercise duration, 6-minute walking distance, and measures of physical fitness such as upper body strength, lower body flexibility, and dynamic balance.
• Exercise adherence was not significantly different between the groups, but more patients in the home-based program than in the center-based program reported walking for 30 minutes or more at least once weekly (P = .003).
• Patients in neither of the groups showed significant changes in disease-related biomarkers.

IN PRACTICE:

“Our study adds evidence supporting the effectiveness of home-based interventions for HF [heart failure] patients receiving optimal contemporary drug treatment, patients with implanted cardiac devices, and patients across the left ventricular ejection fraction spectrum,” the authors wrote.

“The consistent improvements in functional capacity and HRQOL [health-related quality of life] dimensions should encourage the HF community to consider home-based CR [cardiac rehabilitation] programs as a strategic approach to increase the uptake of this recommended treatment,” they added.

SOURCE:

The study was led by Cristine Schmidt, PhD, of the Faculty of Sport at the University of Porto in Porto, Portugal. It was published online on January 29, 2025, in JACC: Heart Failure.

LIMITATIONS:

The study was limited by a higher dropout rate than anticipated and a short follow-up period. The final number of patients assigned to both groups was not balanced, which negatively affected the statistical power. Cardiovascular events, such as deaths or hospitalizations, were not used as primary outcomes. The study population comprised low- to moderate-risk patients, which limited the generalizability of the findings to higher-risk populations.

DISCLOSURES:

This work received support from the FEDER (European Regional Development Fund) and Fundação para a Ciência e Tecnologia, I.P. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.