Home-Based Cardiac Rehabilitation Cuts Death Risk Among Veterans

Published in the Journal of the American Heart Association, a new study found that among US military veterans hospitalized for cardiac issues, those who took part in home-based cardiac rehabilitation experienced a significantly lower chance of death within four years. 

According to the Centers for Disease Control and Prevention (CDC), veterans generally experience a higher risk of heart disease, often due to post-traumatic stress disorder.

The American Heart Association notes that cardiac rehabilitation services can significantly boost outcomes for previously hospitalized cardiac patients. According to the press release, cardiac rehabilitation is a highly underused service, even though research has shown its benefits. The Million Hearts Cardiac Rehabilitation Collaborative, a national initiative co-led by the CDC and Centers for Medicare & Medicaid Services, estimated that 25,000 lives could be saved if patient participation in cardiac rehabilitation increased to 70 percent.

“Whether in a hospital or home, cardiac rehabilitation is all about healthy behavior changes,” said senior study author Mary A. Whooley, MD, a primary care physician at the San Francisco Veterans Affairs (VA) Medical Center and professor of medicine at the University of California, San Francisco, in a press release. “However, changing behaviors is difficult, and while care facilities may offer on-site cardiac rehabilitation, many patients don’t choose to take advantage of follow-up treatment. The biggest surprise of our analysis was how few patients chose to participate in cardiac rehabilitation.”

This latest study adds to evidence of cardiac rehabilitation's clinical benefits for patients.

For the study, researchers examined data for 1,120 veterans eligible for cardiac rehabilitation at the San Francisco VA Medical Center between August 2013 and December 2018.

The study population comprised 98 percent men, 2 percent women, 76 percent White patients, 88 percent non-Hispanic patients, and 68 percent of patients who lived in an urban environment.

Around 50 percent of the study population had been hospitalized for percutaneous coronary intervention, 20 percent for coronary artery bypass grafting, 14 percent for a heart attack, and 18 percent for other issues.

The 12-week home-based cardiac rehabilitation program provided various services and resources such as coaching calls, motivational interviews, and a personal health journal to record vital signs and habits.

The program also provided patients with a blood pressure monitor, a scale, and a stationary bike, if requested. Follow-up calls with staff occurred three and six months after completing the program. Participants were followed for around 4.2 years after hospitalization.

Researchers found that death rates fell among patients in the home-based cardiac rehabilitation program. One year after hospitalization, the death rate for those who participated in the program was 2 percent, compared to a death rate of 4 percent among those that did not.

Also, home-based cardiac rehabilitation program participants experienced a 36 percent lower risk of death compared to non-participants. During the follow-up period, 12 percent of program participants died versus 20 percent of non-participants.

“This study suggests that home-based cardiac rehabilitation is associated with a lower death rate when compared to individuals who receive no cardiac rehabilitation,” said Randal J. Thomas, MD, a professor of medicine at the Mayo Clinic Alix School of Medicine working with the Mayo Clinic Cardiac Rehabilitation Program in Rochester, Minnesota, in a press release. “Previous home-based cardiac rehabilitation studies have not been designed to address this important benefit. Additional studies are needed, but this study strongly suggests a mortality benefit from home-based cardiac rehabilitation.”

Similarly, a study from September 2022 found that home-based cardiac rehabilitation led to positive patient outcomes.

After comparing the outcomes of both home- and center-based cardiac rehabilitation services, researchers found that those in the home-based group experienced lower hospitalization rates.