Abstract 17159: Comparing Functional Status in Home-Based to Facility-Based Cardiac Rehabilitation Participants

Introduction: Cardiac rehabilitation (CR) remains underutilized in patients with ischemic heart disease (IHD). Home-based CR (CR) has been promulgated as a model of delivery that may improve participation, but its impact on functional status is unclear. Hypothesis: We sought to compare change in 6-minute-walk-distance (6MWD) among patients enrolled in home-based vs. facility-based CR after myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery. Methods: We evaluated change in 6MWD among 231 Veterans with IHD via home-based vs. facility-based CR after an IHD event. Between 9/2015 and 9/2017, all eligible patients enrolling in home-based (San Francisco VA) or facility-based CR (VA Ann Arbor and VA Pittsburgh) were invited to participate. 6MWD was assessed at baseline, 3-, and 6-months. Results: Median baseline 6MWD were similar in 116 patients who completed home-based vs. facility-based CR (1155 vs. 1160 ft, p=0.52). Median time from referral to enrollment was shorter for home-based vs. facility-based CR (14 vs. 42 days, p<0.001). At 3 months, patients participating in home-based CR demonstrated greater increase in 6MWD (324 vs. 128 feet; p<0.001). After adjusting for demographics, comorbidities, and clinical indication, the mean 3-month change in 6MWD remained significantly greater (330 feet vs. 127 feet; p<0.001). However, the difference was no longer statistically significant at 6 months of follow-up (295 vs. 191 feet; p=0.10). Conclusions: Participants in home-based CR experienced faster time to enrollment and greater 3-month increases in 6MWD than those in facility-based CR, but differences were no longer significant at 6 months. The early superiority of HBCR may relate to shorter delay from referral to participation. Both groups demonstrated similar safety and efficacy. These findings suggest that among selected patients who cannot attend facility-based CR, home-based CR may provide a reasonable alternative.