Experts urge expansion of home-based cardiac rehabilitation

Home-based cardiac rehabilitation could help many patients recover from heart attacks, surgery or other serious problems, but not enough people get it, a new report says.

New ways of caring for such patients are urgently needed, according to a scientific statement issued Monday by the American Heart Association, American College of Cardiology and the American Association of Cardiovascular and Pulmonary Rehabilitation.

Cardiac rehabilitation is known to reduce the risk of subsequent heart attacks, improve quality of life and help prevent additional hospitalizations. Traditional programs are provided in medical centers. Teams of physicians, nurses, psychologists, registered dietitians and others provide the care.

However, about 80% of U.S. patients who would benefit from such rehabilitation don't participate, Dr. Randal J. Thomas, chair of the writing group for the statement, said in a news release.

"There are significant barriers that prevent patients from getting the cardiac rehabilitation care that they need. And there aren't enough programs in the United States to meet the needs of every patient that would benefit," said Thomas, a professor of medicine and medical director of the cardiac rehabilitation program at Mayo Clinic in Rochester, Minnesota.

"There is an urgent need to find new ways of delivering cardiac rehabilitation programs to patients," he said. "Home-based care is an excellent option for some patients who aren't able to attend a center-based program."

In home-based cardiac rehabilitation, supervision and coaching are done remotely, using smartphones or other technology. Studies show that in many patients whose heart disease is stable, the at-home care results are similar to what patients would receive in a medical center. But it is less clear how home-based care compares with center-delivered rehab for higher-risk patients, the elderly, women and some understudied minority groups, Thomas said.

Most U.S. health care organizations have little experience with home-based cardiac rehabilitation, although health care systems in Great Britain, Canada and other countries offer it successfully.

Unfortunately, Thomas said, home-based rehabilitation is generally not covered by most insurance carriers, including Medicare.

"As more evidence accumulates to support home-based cardiac rehabilitation and the technology advances to make this more feasible, we need to work together with policymakers to find ways for these services to be covered," he said.

For a program done in the home to be effective, Thomas said health care providers should ensure patients are on the right medications, are improving exercise and nutrition habits, and are being monitored for any heart disease symptoms or side effects from medications. Also important to address are risk factors for heart disease such as diabetes, high blood pressure and smoking.

"All of these components should be in place with a high-quality home-based program. If they are not, patients could be receiving less care than they need," Thomas said.

The statement was published in the AHA journal Circulation, the Journal of the American College of Cardiology and the Journal of Cardiopulmonary Rehabilitation and Prevention.

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