J Am Coll Cardiol. 2019 Jul 9;74(1):133-153. doi: 10.1016/j.jacc.2019.03.008. Epub 2019 May 13.
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.
心脏康复（CR）是一种基于证据的干预措施，它使用患者教育、健康行为改变和运动训练来改善心血管疾病患者的二级预防结果。CR 计划可降低美国成年人缺血性心脏病、心力衰竭或心脏手术后的发病率和死亡率，但使用率显著较低，只有少数符合条件的患者参加 CR。迫切需要新的交付策略来提高参与度。一种潜在的策略是家庭为基础的心脏康复（HBCR）。与在医疗监督设施中提供的以中心为基础的 CR 服务不同，HBCR 依赖于远程辅导，通过间接运动监督，主要或完全在传统的以中心为基础的环境之外提供。尽管 HBCR 在英国、加拿大和其他国家已成功部署，但大多数美国医疗保健组织对此类计划几乎没有经验。本科学声明的目的是确定核心组件、疗效、优势、局限性、证据差距和研究的必要性，以指导美国未来 HBCR 的交付。以前的随机试验产生了低到中等强度的证据，表明 HBCR 和以中心为基础的 CR 可以在 3 到 12 个月的临床结果中实现类似的改善。尽管 HBCR 似乎有望扩大 CR 的使用范围，以惠及符合条件的患者，但需要进一步的研究和示范项目来阐明、加强和扩展 HBCR 的证据基础，以关键亚组，包括老年人、妇女、代表性不足的少数群体和其他高风险和研究不足的群体。在此期间，我们的结论是，对于符合条件但无法参加传统以中心为基础的 CR 计划的低到中度风险、临床稳定的选定患者，HBCR 可能是一个合理的选择。
