Cardiac Rehabilitation: The emerging role of home-based approaches and telemedicine

Abstract

Outpatient cardiac rehabilitation programs provide supervised exercise training in addition to secondary prevention interventions. They are designed to speed recovery from acute cardiovascular events, benefit chronic patients and to improve quality of life. Alternative approaches to the delivery of supervised cardiac rehabilitation include home-based programs, disease management and lifestyle health coaching interventions, and other internet-based case management systems. The effectiveness of home-based programs was evaluated in several randomized trials. There was no evidence of a difference in mortality, reinfarction, revascularization, cardiac-associated hospitalization, or exercise capacity between the two modes of intervention. Other alternatives include community-based group programs and the use of telemedicine. Use of mobile health technologies may further expand cardiac rehabilitation availability. Telehealth exercise cardiac rehabilitation appears to be at least as effective as center-based cardiac rehabilitation in improving modifiable cardiovascular risk factors and functional capacity. It identifies the option of telehealth and the technologic advances to provide more comprehensive, responsive, and interactive interventions for individuals for whom center-based rehabilitation is not feasible. The attractiveness of telemedicine models is the potential to improve participation of patients in structured with its short term and long-term benefits.