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

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 he...

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Veröffentlicht in:	Circulation (New York, N.Y.) Jg. 140; H. 1; S. e69
Hauptverfasser:	Thomas, Randal J, Beatty, Alexis L, Beckie, Theresa M, Brewer, LaPrincess C, Brown, Todd M, Forman, Daniel E, Franklin, Barry A, Keteyian, Steven J, Kitzman, Dalane W, Regensteiner, Judith G, Sanderson, Bonnie K, Whooley, Mary A
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 02.07.2019
Schlagworte:	American Heart Association Cardiac Rehabilitation - methods Cardiac Rehabilitation - standards Cardiology - methods Cardiology - standards Cardiovascular Diseases - diagnosis Cardiovascular Diseases - epidemiology Cardiovascular Diseases - therapy Clinical Trials as Topic - methods Clinical Trials as Topic - standards Exercise Therapy - methods Exercise Therapy - standards Home Care Services - standards Humans Lung Diseases - diagnosis Lung Diseases - epidemiology Lung Diseases - rehabilitation United States - epidemiology United States exercise behavior therapy patient education cardiac rehabilitation AHA Scientific Statements
ISSN:	1524-4539, 1524-4539
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Abstract	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.
AbstractList	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.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. 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.
Author	Sanderson, Bonnie K Beckie, Theresa M Forman, Daniel E Whooley, Mary A Franklin, Barry A Regensteiner, Judith G Brown, Todd M Kitzman, Dalane W Brewer, LaPrincess C Keteyian, Steven J Thomas, Randal J Beatty, Alexis L
Author_xml	– sequence: 1 givenname: Randal J surname: Thomas fullname: Thomas, Randal J – sequence: 2 givenname: Alexis L surname: Beatty fullname: Beatty, Alexis L – sequence: 3 givenname: Theresa M surname: Beckie fullname: Beckie, Theresa M – sequence: 4 givenname: LaPrincess C surname: Brewer fullname: Brewer, LaPrincess C – sequence: 5 givenname: Todd M surname: Brown fullname: Brown, Todd M – sequence: 6 givenname: Daniel E surname: Forman fullname: Forman, Daniel E – sequence: 7 givenname: Barry A surname: Franklin fullname: Franklin, Barry A – sequence: 8 givenname: Steven J surname: Keteyian fullname: Keteyian, Steven J – sequence: 9 givenname: Dalane W surname: Kitzman fullname: Kitzman, Dalane W – sequence: 10 givenname: Judith G surname: Regensteiner fullname: Regensteiner, Judith G – sequence: 11 givenname: Bonnie K surname: Sanderson fullname: Sanderson, Bonnie K – sequence: 12 givenname: Mary A surname: Whooley fullname: Whooley, Mary A
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/31082266$$D View this record in MEDLINE/PubMed
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SubjectTerms	American Heart Association Cardiac Rehabilitation - methods Cardiac Rehabilitation - standards Cardiology - methods Cardiology - standards Cardiovascular Diseases - diagnosis Cardiovascular Diseases - epidemiology Cardiovascular Diseases - therapy Clinical Trials as Topic - methods Clinical Trials as Topic - standards Exercise Therapy - methods Exercise Therapy - standards Home Care Services - standards Humans Lung Diseases - diagnosis Lung Diseases - epidemiology Lung Diseases - rehabilitation United States - epidemiology
Title	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
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