Improving the Delivery of Home-Based Cardiac Rehabilitation at a VA Medical Center

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Abstract

Introduction: Despite overwhelming evidence and widespread endorsement, service utilization, uptake and patient adherence to cardiac rehabilitation (CR) programs remain suboptimal.

Purpose: Home-CR models have the potential of increasing CR uptake and adherence, thereby optimizing enrollment with improved access.

Significance: Less than 10% of all eligible veterans receive CR services. Currently, no VA facility-based CR programs exist in the Northern California region.

Design: The Healthy Heart Program at the San Francisco VA Medical Center is a physician-directed, nurse case-managed, customized exercise and lifestyle home-based program. The core components of this program include: nutrition and weight management, blood pressure, lipid and diabetes management, medication adherence, smoking cessation, psychosocial support and outcome assessment. Patients enrolled into the 12-week phase II home-based program are given home exercise equipment and workbook. Participants are contacted over the telephone for weekly therapy sessions.

Results:Since its inception, the Healthy Heart Program has dramatically increased the proportion of eligible Veterans participating in cardiac rehabilitation at the SFVA, from

Conclusions: Home-based CR programs at VA medical centers have the potential of optimizing CR enrollment and adherence, thereby reducing cardiac risk factors and hospital readmissions.

Implications: Home-based CR will help to increase the number of participants who participate by expanding the reach of cardiac risk factor management programs beyond the setting of the traditional, supervised structured setting. A home-based program will be a valuable addition to facility-based programs, as a stand-alone program or adopted into a hybrid program.