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Practice Guideline
. 2019 Jul 9;74(1):133-153.
doi: 10.1016/j.jacc.2019.03.008. Epub 2019 May 13.

Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology

Randal J Thomas, Alexis L Beatty, Theresa M Beckie, LaPrincess C Brewer, Todd M Brown, Daniel E Forman, Barry A Franklin, Steven J Keteyian, Dalane W Kitzman, Judith G Regensteiner, Bonnie K Sanderson, Mary A Whooley
Practice Guideline

Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology

Randal J Thomas et al. J Am Coll Cardiol. .

Abstract

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.

Keywords: AHA Scientific Statements; behavior therapy; cardiac rehabilitation; exercise; patient education.

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Figures

Figure 1.
Figure 1.
Target health behaviors for cardiac rehabilitation.
Figure 2.
Figure 2.
Structure, process, and outcome metrics for home-based cardiac rehabilitation.
Figure 3.
Figure 3.
Key opportunities to increase patient engagement in cardiac rehabilitation.
See this image and copyright information in PMC

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