Abstract 164: Home-Based Cardiac Rehabilitation Improves Access for Rural Veterans

Abstract

Objective: Referral to cardiac rehabilitation (CR) is one of nine performance measures for patients with ischemic heart disease (IHD), but fewer than 10% of eligible Veterans participate. Home-based CR programs may improve participation in CR, particularly for rural Veterans who do not live near traditional facility-based programs. We sought to compare referral to, participation in, and completion of CR in rural and urban Veterans. Methods: We established The Healthy Heart Program, a home-based CR program, to increase participation in CR programs and provide an alternative to facility-based CR programs for Veterans with IHD. Between August 2013 and May 2015, 574 patients were referred to CR during hospitalization for myocardial infarction, coronary revascularization, valve surgery, angina, or as an outpatient with heart failure. We used the Rural-Urban Commuting Areas (zip code) system to categorize urban and rural Veterans. We then compared the proportions of urban vs. rural Veterans who were referred to, enrolled in, and completed home-based CR. Results: Overall, 52% (94/181) of rural and 51% (202/393) of urban Veterans agreed to enroll in CR. Rural Veterans were more likely to be married (50% vs. 41%, p=0.02) and have undergone coronary artery bypass surgery (30% vs. 20%, p=0.03). Among 296 patients who agreed to enroll, 82% chose home-based and 18% chose facility-based CR (p<0.001). Rural Veterans were more likely than urban Veterans to choose home-based CR (95% vs. 76%; p<0.001). Among 243 patients who enrolled in home-based CR, rural Veterans were more likely to complete at least 9 weeks of home-based CR (67% vs. 53%; p=0.031) and less likely to withdraw (33% vs. 47%, p=0.031). After adjustment for demographics and clinical indication, rural Veterans had 49% greater odds of enrolling in (odds ratio 1.49, 95% confidence interval 1.03, 2.14; p=0.034) and 80% greater odds of completing home-based CR (OR 1.80, 95% CI 1.20, 2.71; p=0.004). Conclusion: The majority of Veterans who were interested in CR chose a home-based over a facility-based program. Rural Veterans were more likely to choose home-based CR and to complete CR. Home-based CR is an effective way of engaging patients who may otherwise decline to participate in CR, especially for rural Veterans.