More diverse and medically complex patients hospitalized less often after home-based cardiac rehabilitation

While previous studies have indicated that home and center-based cardiac rehabilitation lead to similar outcomes for low-risk patients, information about patients who are more medically complicated and racially and ethnically diverse is unknown. .

According to a study published Thursday in Open JAMA Network.

Previous studies have suggested that participation in home and center-based cardiac rehabilitation lead to similar clinical outcomes in patients at low to moderate risk. However, the outcomes of demographically diverse populations and patients who had other chronic diseases and other complex comorbidities had not been studied.

To add to what is known about home-based cardiac rehabilitation, Kaiser Permanente researchers analyzed patients from Kaiser Permanente Southern California (KPSC), an integrated health care system that serves 4.7 million members in racially and ethnically diverse Southern California.

They compared 12-month hospitalizations, medication adherence and control of cardiovascular risk factors in high-risk complex patients. The 2556 patients participated in cardiac rehabilitation from April 1, 2018 to April 30, 2019, with follow-up through April 30, 2020. Data were analyzed from January 2021 to January 2022.

The mean (SD) age was 66.7 (11.2) years; almost 30% were women. Nearly 47% had a Charlson comorbidity index ≥4. More than half (55.5%) of the patients were white; 11.3% were Asian or Pacific Islander; 7.6% were 193 black; and 3.9% were Hispanic.

Participants were split between home-based cardiac rehabilitation (HBCR) and center-based cardiac rehabilitation (CBCR), with 1241 participants (48.5%) receiving HBCR and 1315 participants (51.5%) receiving CBCR.

Logistic regression was used to compare hospitalization, medication adherence, and control of cardiovascular risk factors, with inverse probability treatment weighting (IPTW) to adjust for demographic and clinical characteristics.

Patients who participated in HBCR were 21% less likely to be hospitalized within 12 months of cardiac rehabilitation compared to patients who participated in CBHR (odds ratio [OR], 0.79; 95% CI, 0.64-0.97).

However, other results between the 2 groups receiving different types of similar therapies:

  • Adherence to beta-blockers (OR, 1.18; 95% CI, 0.98-1.42) and statins (OR, 1.02; 95% CI, 0.84-1.25)
  • Blood pressure control (OR, 0.98; 95% CI, 0.81-1.17)
  • Low-density lipoproteins LDL cholesterol Low-density lipoprotein cholesterol (OR, 0.98; 95% CI, 0.81-1.20),
  • Hemoglobin HbA1c (OR, 0.98; 95% CI, 0.82-1.18)

Additionally, HBCR participants, who lived farther from their nearest available center, were more likely to complete their program.

Although cardiac rehabilitation is recommended after a cardiovascular event, previous studies have shown that up to 80% of eligible patients do not participate, with women, people with multiple chronic conditions, and members of certain racial and ethnic groups being more likely not to participate.

HBCR was developed to increase participant diversity by improving accessibility. Kaiser Permanente’s 8-week HBCR includes weekly nursing calls, training, and unsupervised exercise monitored with a smartwatch. Providers can review data, including step count and heart rate, through a dashboard in the electronic health record and adjust the program as needed.

The authors stated that to their knowledge, this was the largest study of cardiac rehabilitation and “the first study to report superior clinical outcomes in HBCR compared to CBCR and the first to examine hospitalizations as an outcome.” major”.

They noted that one limitation that may have affected the results is that the decision to refer patients to HBCR or CBCR belonged to the patient’s cardiologist, which may have introduced physician referral bias.

“The remarkable thing we found in this study of over 2,500 diverse patients was that the health benefits of home-based cardiac rehabilitation applied to both low- and moderate-risk patients, as well as to those at higher risk due to poor health, age, or chronic health conditions,” lead author Chileshe Nkonde-Price, MD, cardiologist at Kaiser Permanente West Los Angeles Medical Center, clinician scientist at Kaiser Permanente Southern California Department of Research & Evaluation and Adjunct Professor at Kaiser Permanente Bernard J. Tyson School of Medicine, said in a press release.

Reference

Nkonde-Price C, Reynolds K, Najem M, et al. Comparison of home and center-based cardiac rehabilitation in hospitalization, medication adherence, and risk factor control in patients with cardiovascular disease. JAMA Netw Open. 2022;5(8):e2228720. doi:10.1001/jamanetworkopen.2022.28720

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