Retrospective Comparison of Outcomes and Cost of a Virtual vs. Center-Based Cardiac Rehabilitation Program

Abstract

Background: Despite robust evidence supporting an association with improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underutilized, with a minority of eligible patients participating. Virtual cardiac rehabilitation (VCR) has been proposed as an alternative to traditional center-based CR (CBCR) to improve utilization rates. However, data supporting the efficacy and cost-effectiveness of VCR is limited. In the present study, we compared the outcomes and cost of a VCR vs. traditional CBCR program. Methods: Retrospective cohort study comparing VCR vs. CBCR. CBCR data were collected from a period of January 2018 to September 2023. VCR data were collected from program initiation in July 2021 to September 2023. Primary health outcomes measured were 1-year mortality rates, recurrent MI, all-cause hospital readmission, and emergency department visits. Primary cost outcomes were analyzed as cost ratios related to VCR vs. CBCR assessing total medical costs allowed, pharmacy costs, and total costs of care over the 12 months post-CR enrollment. Results: VCR was associated with a significant reduction in 1-year all-cause hospital readmission (incident rate ratio (IRR)=0.616, 95% confidence interval (CI): 0.489, 0.777, p<0.001) and ED admission (IRR=0.557, 95% CI: 0.452, 0.687, p<0.001) at 1 year. The IRR of MI and all-cause mortality did not significantly differ between VCR and CBCR. In addition, VCR was associated with significant reductions in medically related (cost ratio=0.814, 95% CI: 0.690, 0.960, p=0.0144) and total costs (cost ratio=0.838, 95% CI: 0.725, 0.970, p=0.0176). Conclusion: VCR is a viable alternative to CBCR with at least comparable efficacy and cost, and as such, represents a key mechanism for improving access to and participation in CR for eligible patients.