Heart failure patients see benefits from home-based rehab
Home-based cardiac rehabilitation (CR) programs for heart failure (HF) are noninferior to CR programs that occur at a hospital, according to a new analysis published in JACC: Heart Failure.[1]
“CR is endorsed by international guidelines due to its consistent improvement in health-related quality of life and functional capacity among patients with HF,” wrote first author Cristine Schmidt, PhD, a researcher with the University of Porto in Portugal, and colleagues. “A systematic review and meta-analysis have further indicated that CR reduces the risk of all-cause hospitalizations and HF-specific hospitalizations. However, despite these benefits, registry data reveal that only a minority of HF patients engage in CR programs. This widely recognized evidence-treatment gap has motivated the study of new modes of CR delivery such as home-based programs.”
Schmidt et al. examined the potential benefits of home-based CR programs by randomly assigning 120 adult patients to either undergo home-based or center-based CR for 12 weeks. Patients presented at a mean age of 62 years old with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF).
The home-based patients wore a smartwatch linked to either a computer or a smartphone application, going through the same exercise training program as center-based patients. They were also instructed to walk twice per week, take part in weekly phone calls about their progress and discuss potential lifestyle modifications with a healthcare professional. These patients also completed supervised training at the hospital prior to starting their home-based program to ensure they were familiar with the movements.
Overall, home-based CR was found to be noninferior to center-based CR. The study’s primary endpoint—mean change in peak oxygen uptake (Vo2peak) after 12 weeks—was 1.40 for the home-based patients and 0.58 for the center-based patients. In addition, there were no significant differences between the two groups when it came to measuring six-minute walking distance, quality-of-life scores, disease-related biomarkers and physical fitness.
“These findings underscore the resilience and adaptability of CR interventions, which have proven effective even in the face of the challenges posed by the COVID-19 pandemic,” the authors wrote.
Schmidt et al. also addressed the below-average change in Vo2peak associated with center-based CR in this analysis, noting that the pandemic may have played a major role.
“The safety measures adopted during the COVID-19 pandemic might have impacted negatively the performance during the exercise training sessions,” they explained. “Among these measures, the use of face masks during exercise training sessions may have hindered the participants' ability to achieve optimal performance and consequently impacted their Vo2peak improvement.”
The group concluded by looking to the future, noting that home-based CR should be seen as a valid treatment option for HFrEF and HFpEF patients. This helps improve patient access to this important therapy and could lead to better long-term outcomes among a high-risk population.
Click here to read the full study in JACC: Heart Failure, an American College of Cardiology journal.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.