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 Medically supervised rehab programs focused on things like stress
reduction, exercise and heart healthy living have long been linked
to better survival odds, fewer hospitalizations, and improved
quality of life after a heart attack or cardiac procedure. But most
patients don't start rehab or stick with it as long as they should
because of barriers like a lack of insurance or the inconvenience of
needing to travel and take time off work every time they go to rehab
at a hospital.
For the four in five patients who currently don't do recommended
cardiac rehab, home-based programs may be a viable alternative,
according to a scientific statement published today by the American
Heart Association, the American College of Cardiology, and the
American Association of Cardiovascular and Pulmonary Rehabilitation.
"Patients who experience a cardiac event (such as a heart attack or
heart surgery), should participate in a cardiac rehabilitation
program," said lead author of the statement Dr. Randal Thomas,
medical director of the cardiac rehab program at the Mayo Clinic in
Rochester, Minnesota.
"Such programs help patients recover better, feel healthier, and
live longer," Thomas said by email. "Patients who are not able to
participate in a center-based cardiac rehabilitation program due to
distance, cost, or other barriers, should discuss with their
healthcare provider the possibility of participating in a home-based
cardiac rehabilitation program."
Traditional cardiac rehabilitation programs are provided in a
medical center and are implemented by a team of physicians, nurses,
psychologists, registered dieticians and other professionals.
They help patients recover from heart attacks, bypass surgery,
angioplasty, heart failure and other conditions through a program of
exercise training, nutrition and psychological counseling tailored
to each individual's needs.
A successful home-based cardiac rehab program would still be
supervised by clinicians, but help cut down on hospital visits. It
might include customized workout programs or eating plans and
involve regular check-ins by phone to make sure patients stay on
track.
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For stable and low-risk patients, some research already suggests
that home-based rehab may work as well as hospital based programs,
according to the statement published in Circulation.
What isn't as clear is how home-based care compares with
hospital-based programs for higher-risk cardiac patients, the
elderly, women and some understudied minority groups.
And much of the research suggesting home-based rehab works as well
as hospital programs hasn't followed patients beyond one year, said
Dr. Hani Jneid, director of interventional cardiology at the Michael
DeBakey VA Medical Center and Baylor College of Medicine in Houston.
"Therefore, it is best to reserve home-based cardiac rehab to those
at low-or-moderate risk who are unable to receive center-based
cardiac rehab for a variety of reasons," Jneid, who wasn't involved
in the statement, said by email.
Still, there's so much room for improvement in cardiac rehab
participation rates that even some home-based programs could be a
big benefit for patients, said Dr. Chip Lavie, of the Ochsner
Clinical School-University of Queensland School of Medicine in
Australia.
"It is not realistic to get even close to 100 percent attendance,
but getting 30 to 50 percent attendance would be really dramatic
improvements," Lavie, who wasn't involved in the study, said by
email. "Certainly, cardiac rehab needs to be re-branded and
re-invigorated in the 21st century."
SOURCE: http://bit.ly/2JEAgrE Circulation, online May 13, 2019.
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