Home-based rehabilitation is no worse than hospital-based programmes for helping patients get better after a heart attack or surgery to clear blocked heart arteries. It has been known for long that the risk of death is lower among heart patients who participate in exercise-based rehabilitation programmes, but most patients do not complete these programmes. Women, older people, and minorities are even less likely to enter these programmes and complete them. To investigate whether offering patients the chance to do a rehabilitation programme at home might improve adherence, researchers from the UK randomly assigned 525 patients living in England's West Midlands region to a home or traditional hospital-based rehab programme. The hospital programmes, offered at four different centers were 8 to 12 weeks long, and began 4 to 8 weeks after a patient's heart attack or revascularization surgery. The home programmes included visits from rehab nurses at 10 days, 6 weeks and 12 weeks after discharge from the hospital and a telephone contact 3 weeks after discharge, as well as additional visits if the nurse thought them necessary. Both programmes were based on the Heart Manual developed that recommends patients to gradually increase their activity until they are doing at least 15 minutes of moderate intensity exercise daily. Among patients in the home-based group, 96 percent had at least 5 contacts with rehab nurses, in person or by phone, while just 56 percent of the hospital-based programme participants attended at least 5 classes. But at 1 year, the researchers found no clinically significant differences in blood pressure, cholesterol levels, mental health, smoking cessation or exercise ability between the two groups. While the home program was more expensive than the hospital programme, the cost difference disappeared once the researchers took travel expenses and other costs to the patient into account. The study indicate that the provision of a home-based service alongside the hospital services would provide choice for patients and might improve uptake and adherence in patients who are not willing or able to attend a hospital.
Heart
January 2009
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