Home-based vs. outpatient clinic rehabilitation: a historical cohort study comparing morbidity and mortality outcomes in low-mild risk cardiac patients during and after the rehabilitation treatment

Introduction: Ischemic heart disease (IHD) is the leading cause of death globally. In Israel, IHD is the second most common cause of death after cancer, accounting for 22% of all deaths during 2020 to 2022. Despite the known benefits of cardiac rehabilitation (CR), only 10% to 41% of eligible patients participate in such programs. Home-based cardiac rehabilitation (HBCR) has been developed to increase participation rates. This study aimed to evaluate patients in HBCR, comparing their rates of emergency department readmissions, rehospitalizations, and mortality with those in center-based cardiac rehabilitation (CBCR) within 1-year of joining the CR program.

Methods: We conducted a historical cohort study at Sheba Medical Center, comparing low-risk cardiac patients who participated in CBCR versus those who participated in HBCR during the years 2019-2022. Patients who experienced severe orthopedic or neurological impairments or did not complete at least 4 CR sessions were excluded. Analytical methods included Kaplan-Meier survival analysis, and Cox proportional-hazard models, adjusted for age, sex, dyslipidemia and atrial fibrillation/flutter.

Results: The study included 731 patients (CBCR, n=463; HBCR, n=268). Patients in the HBCR group were younger by four years (57.3±10.6) on average compared to CBCR participants (61.4 ±11.7). During 1-year follow-up, 85 patients experienced a rehospitalization event (CBCR: n=59; HBCR, n=26), with no statistically significant differences between groups (HR=0.72; 95% CI: 0.45-1.14). Additionally, 192 patients were admitted to the emergency department (CBCR, n=130; HBCR, n=62), with no statistical differences (HR=0.78; 95% CI: 0.58-1.07). Only one patient, from the HBCR died within the follow-up period.

Conclusions: Home-based rehabilitation was associated with a lower rate of emergency room admissions and rehospitalizations, compared to ambulatory care. These findings support home-based rehabilitation as a feasible and safe alternative for low-risk patients. A randomized controlled trial is warranted to further validate the safety and effectiveness of home-based cardiac rehabilitation.