Author + information
- Published online May 13, 2019.
- Randal J. Thomas, MD, MS, MAACVPR, FAHA, FACC, Chair,
- Alexis L. Beatty, MD, MAS, MAACVPR, FACC,
- Theresa M. Beckie, PhD, MSN, FAHA,
- LaPrincess C. Brewer, MD, MPH, FACC,
- Todd M. Brown, MD, FAACVPR, FACC,
- Daniel E. Forman, MD, FAHA, FACC,
- Barry A. Franklin, PhD, MAACVPR, FAHA,
- Steven J. Keteyian, PhD,
- Dalane W. Kitzman, MD, FAHA,
- Judith G. Regensteiner, PhD, FAHA,
- Bonnie K. Sanderson, PhD, RN, MAACVPR and
- Mary A. Whooley, MD, FAHA, FACC, Vice Chair
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.
The American Heart Association, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the American College of Cardiology make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
This document was approved by the American Heart Association Board of Directors in July 2018, the Science Advisory and Coordinating Committee in September 2018, and the Executive Committee in October 2018; the American Association of Cardiovascular and Pulmonary Rehabilitation Document Oversight Committee in July 2018; and the American College of Cardiology Clinical Policy Approval Committee in August 2018.
A Data Supplement is available with this article at http://jaccjacc.acc.org/Clinical_Document/Cardiac_Rehab_Data_Supplement_Revised.pdf.
The American College of Cardiology Foundation requests that this document be cited as follows: Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ, Kitzman DW, Regensteiner JG, Sanderson BK, Whooley MA. 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. J Am Coll Cardiol 2019;xx:xx–xx.
This article has been copublished in the Journal of Cardiopulmonary Rehabilitation and Prevention and Circulation.
Copies: This document is available on the websites of the American Heart Association (www.professional.heart.org), the American Association of Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org), and the American College of Cardiology (www.acc.org). For copies of this document, please contact Elsevier Inc. Reprint Department, fax (212) 633-3820, email .
Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology. Requests may be completed online via the Elsevier site (https://www.elsevier.com/about/ourbusiness/policies/copyright/permissions).
- 2019 American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, Inc., and the American College of Cardiology Foundation
- Evidence from Published Studies Comparing HBCR and CBCR
- Core Components of HBCR Interventions
- Effects of HBCR Compared With CBCR
- Key Factors Associated With Successful Implementation of HBCR
- Challenges and Potential Solutions in HBCR
- Considerations for Quality Metrics for HBCR
- Technology Tools and HBCR
- Areas for Future Work
- Conclusions and Suggestions for Clinicians, Healthcare Organizations, Third-Party Payers, and PolicyMakers