Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study

Abstract

AimAlthough cardiac rehabilitation improves physical fitness after a cardiac event, many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time. Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness.Methods and resultsWe randomised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training. Although training adherence was similar between groups, satisfaction was higher in the home-based group (p = 0.02). Physical fitness improved at discharge (p < 0.01) and at one-year follow-up (p < 0.01) in both groups, without differences between groups (home-based p = 0.31 and centre-based p = 0.87). Physical activity levels did not change during the one-year study period (centre-based p = 0.38, home-based p = 0.80). Healthcare costs were statistically non-significantly lower in the home-based group (€437 per patient, 95% confidence interval –562 to 1436, p = 0.39). From a societal perspective, a statistically non-significant difference of €3160 per patient in favour of the home-based group was found (95% confidence interval –460 to 6780, p = 0.09) and the probability that it was more cost-effective varied between 97% and 75% (willingness-to-pay of €0 and €100,000 per quality-adjusted life-years, respectively).ConclusionWe found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness, physical activity level or health-related quality of life. However, home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training. We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation.

The Imperative for Patient-Centered Clinical Decision Support

“…Empowering patients to control aspects of their care goes a long way to improving care quality. Research findings support this: compared with patients that do not, patients who participate in medical decisions tend to report more satisfaction with their care [5], enjoy a better quality of life [6], and are adherent to recommendations [7] with greater satisfaction [8]. …”

FIT@Home editorial: Supporting a new era of cardiac rehabilitation at home?

“…The FIT@Home study is a randomized, controlled clinical trial, comparing home-based with centre-based cardiac rehabilitation 7 in ischaemic heart disease patients (N ¼ 90). Home-based patients entered a three-month exercise training programme at home, supervised remotely by heart rate and physical activity telemonitoring.…”

Providing heart failure rehabilitation in the home via telerehabilitation

“…For example, Piotrowicz and colleagues (2015b) found higher exercise capacity and adherence rates in patients with CHF who undertook an eight week home-based telemonitored Nordic walking program, compared with a control group of no exercise. Another study demonstrated that home-based telemonitored exercise results in similar improvements in exercise capacity and health-related quality of life compared with a centre-based exercise in low-to-moderate cardiac risk patients entering cardiac rehabilitation (Kraal et al, 2017).…”

“…In particular, telerehabilitation is at least as effective as traditional centre-based rehabilitation programs for patients with cardiopulmonary diseases, in terms of exercise capacity as measured by the 6 minute walk test (6MWT) and peak oxygen consumption (Frederix et al, 2015a;Tsai et al, 2017), quality of life (Holland et al, 2016;Piotrowicz et al, 2010), and adverse events (Arthur et al, 2002;Piotrowicz et al, 2015b). Telerehabilitation has higher adherence rates (Piotrowicz et al, 2010;Varnfield et al, 2014), higher patient satisfaction levels and appears to be more cost-effective compared with centre-based programs Kraal et al, 2017). As this is a relatively new research area, there are only a few studies in each disease and the majority used phone-based telerehabilitation.…”

“…However it is unclear if patients in the centre-based group received weekly coaching sessions comparable to the telerehabilitation group (Kraal et al, 2017). Similarly, studies on text messaging and phone communications with healthcare professionals also demonstrated improved exercise capacity (Frederix et al, 2015a), increased program completion rates (Varnfield et al, 2014), improved risk factors for cardiovascular disease (Chow et al, 2015) and cost effectiveness compared with a control group of patients undertaking traditional cardiac rehabilitation.…”