Stratification of Patients in Cardiac Rehabilitation as Novel Programs Develop

Abstract

PURPOSE: While cardiac rehabilitation (CR) programs such as home-based (HB) and hybrid (H) are widely touted for convenience and adherence, it remains unclear which patients are best suited for these models. Current standards of risk stratification are modeled for traditional facility-based (FB) CR and based primarily on cardiovascular (CV) risk. We evaluated baseline differences between patients enrolling in HB vs. H vs. FB vs. No-CR. METHODS: In a retrospective quality improvement analysis of 295 Veterans assessed for CR we evaluated comorbidities, distance to facility, physical function (6 minute walk distance [6MWD], gait speed [GS], tandem stand [TS]), and health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM]) to compare Veterans enrolled in HB, H, FB, and no CR. RESULTS: Patients enrolling in HB care tended to reside farther from facilities. FB-CR was highly preferred by HF patients, while post-CABG patients were more likely to enroll in HB or H- CR. Patients enrolling in HB/H CR had better physical function than patients in FB-CR. Patients that did not enroll in any CR exhibited significantly poorer health literacy. HF, depression, and T2DM differed in there distribution of CR programs, but other comorbidities had little impact on treatment pathways.Table: No title available.Conclusion: Functional metrics constituted the most significant differences between patients who attended HB/H vs. FB, whereas CV risk is the more significant factor between HB vs H. These data suggest that further refinement of risk assessment for HB/H-CR may be warranted to determine minimum thresholds of functional capacity that enable HB/H-CR to be feasible and successful.