There’s No Place Like Home (Care)

GPT Summary: Home-based cardiac rehabilitation (HBCR) programs may provide a viable and effective alternative to traditional facility-based cardiac rehabilitation (CR) programs, according to a study conducted at the San Francisco Veterans Health Administration. The study showed that HBCR reduced mortality rates by 36% compared to non-participants. Digital health advances, at-home monitoring devices, telehealth, wearables, and health apps may play a crucial role in transforming cardiac rehabilitation and improving patient outcomes in the future by enabling remote monitoring, personalized care, and greater access to healthcare services. HBCR offers a patient-friendly path for care that is accessible and convenient.

At-home monitoring, digital health advances, technology, and 5G can play a crucial role in driving the transformation of cardiac rehabilitation and improving patient outcomes. These technologies can provide patients with greater access to healthcare services and support, enable remote monitoring, and facilitate more personalized care. In recent years, there has been a growing interest in home-based cardiac rehabilitation (HBCR) programs as an alternative to traditional facility-based cardiac rehabilitation (CR) programs.  This methodology offers many potential advantages for both patient and clinician.

Remote monitoring: Digital health advances and at-home monitoring devices can allow healthcare providers to remotely monitor patients’ vital signs, medication adherence, and other health metrics. This can enable early detection of complications and prompt interventions, reducing the risk of adverse events and improving patient outcomes.

Personalized care: With the help of digital health tools, healthcare providers can tailor cardiac rehabilitation programs to individual patients’ needs, preferences, and medical histories. This can improve patient engagement and adherence to the program and increase the chances of successful outcomes.

Telehealth: Telehealth technologies, enabled by 5G networks, can facilitate remote consultations between patients and healthcare providers, eliminating the need for in-person visits. This can improve access to healthcare services for patients who live in remote or underserved areas or who have mobility issues.

Wearables: Wearable devices such as smartwatches and fitness trackers can help patients monitor their activity levels, heart rate, and other health metrics. This data can be shared with healthcare providers, enabling them to track patients’ progress and adjust their rehabilitation programs accordingly.

Health apps: Mobile health apps can provide patients with access to educational resources, medication reminders, and other support tools. They can also enable patients to track their progress, set goals, and receive feedback and encouragement from their healthcare providers.

The comfort of home. The home environment can facilitate lifestyle modifications within a patient’s own comfort zone and provide direct family support

A new study has advanced the discussion on home care and the potential role of digital health. In a large and comprehensive clinical trial conducted at the San Francisco Veterans Health Administration compared the mortality rates of patients who participated in HBCR versus those who did not. The study included 1120 patients who were referred and eligible for outpatient CR between 2013 and 2018. Of these patients, 490 chose to participate in HBCR, while 630 chose to attend facility-based CR or did not participate in CR at all.

The results of the study showed that patients who participated in HBCR had a 36% lower hazard of mortality compared to those who did not participate in any CR program. During the median follow-up of 4.2 years, 185 patients (17%) died, and mortality was significantly lower among the HBCR participants (12%) compared to the nonparticipants (20%).

HBCR programs typically involve telephonic coaching and motivational interviewing sessions over a 12-week period, allowing patients to participate in rehabilitation from the comfort of their homes.  In addition, participants received equipment on an as‐needed basis, including resistance bands, a scale, a blood pressure cuff, a pedometer, a heart rate monitoring device, an exercise peddler or stationary bike, and a dietary video. 

This type of program is particularly beneficial for patients who cannot attend traditional CR programs due to various reasons, such as transportation issues, lack of access to facilities, or personal preferences.

Although this study has limitations, it suggests that HBCR may provide a viable and effective alternative to traditional facility-based CR programs. This finding is particularly relevant in the context of the COVID-19 pandemic, which has disrupted access to healthcare services, including CR programs. HBCR programs may offer a safe and effective option for patients to continue their cardiac rehabilitation without the need for in-person visits. Future studies can build upon these insights and incorporate advancing digital health monitoring devices for added data capture and to support analytics that drive frequent physician and patient feedback.

At-home monitoring, digital health advances, technology, and 5G can play a key role in transforming cardiac rehabilitation and improving patient outcomes. These technologies can enable remote monitoring, personalized care, telehealth, wearables, and health apps, among other benefits. By harnessing these tools, healthcare providers can provide patients with more accessible, convenient, and effective cardiac rehabilitation programs, ultimately saving lives.  But more importantly, current clinical data validate this concept and offer a life-saving path, accessible, and patient-friendly path for care.