VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City (Ms Drwal, Drs Wakefield and El Accaoui, and Mr Haraldsson); The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City (Ms Drwal, Dr Wakefield, and Mr Haraldsson); Sinclair School of Nursing, University of Missouri, Columbia (Dr Wakefield); VA Pittsburgh Healthcare System, Pittsburgh, Department of Medicine, University of Pittsburgh, Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Forman); Center of Innovation in Long Term Services and Support, Providence VA Medical Center, Providence, Cardiovascular Rehab Center, Miriam Hospital, Providence, and Alpert Medical School and School of Public Health, Brown University, Providence, Rhode Island (Dr Wu); and Division of Cardiovascular Medicine, University of Iowa, Iowa City (Dr El Accaoui).
J Cardiopulm Rehabil Prev. 2021 Mar 1;41(2):93-99. doi: 10.1097/HCR.0000000000000594.
The conceptual utility of home-based cardiac rehabilitation (HBCR) is widely acknowledged. However, data substantiating its effectiveness and safety are limited. This study evaluated effectiveness and safety of the Veterans Affairs (VA) national HBCR program.
Veterans completed a 12-wk HBCR program over 18 mo at 25 geographically dispersed VA hospitals. Pre- to post-changes were compared using paired t tests. Patient satisfaction and adverse events were also summarized descriptively.
Of the 923 Veterans with a mean age of 67.3 ± 10.6 yr enrolled in the HBCR program, 572 (62%) completed it. Findings included significant improvements in exercise capacity (6-min walk test distance: 355 vs 398 m; P < .05; Duke Activity Status Index: 27.1 vs 33.5; P < .05; self-reported steps/d: 3150 vs 4166; P < .05); depression measured by Patient Health Questionnaire (6.4 vs 4.9; P < .0001); cardiac self-efficacy (33.1 vs 39.2; P < .0001); body mass index (31.5 vs 31.1 kg/m2; P = .0001); and eating habits measured by Rate Your Plate, Heart (47.2 vs 51.1; P < .05). No safety issues were related to HBCR participation. Participants were highly satisfied.
The VA HBCR program demonstrates strong evidence of effectiveness and safety to a wide range of patients, including those with high clinical complexity and risk. HBCR provides an adjunct to site-based programs and access to cardiac rehabilitation. Additional research is needed to assess long-term effects, cost-effectiveness, and sustainability of the model.
家庭心脏康复（HBCR）的概念效用得到广泛认可。然而，支持其有效性和安全性的数据有限。本研究评估了退伍军人事务部（VA）全国 HBCR 计划的有效性和安全性。
退伍军人在 25 家分布在各地的 VA 医院，在 18 个月内完成了为期 12 周的 HBCR 计划。使用配对 t 检验比较治疗前后的变化。还对患者满意度和不良事件进行了描述性总结。
在参加 HBCR 计划的 923 名平均年龄为 67.3±10.6 岁的退伍军人中，有 572 名（62%）完成了计划。研究结果包括：运动能力显著提高（6 分钟步行试验距离：355 对 398 米；P<.05；杜克活动状态指数：27.1 对 33.5；P<.05；自我报告的步数/天：3150 对 4166；P<.05）；患者健康问卷（PHQ）评估的抑郁症状（6.4 对 4.9；P<.0001）；心脏自我效能（33.1 对 39.2；P<.0001）；体重指数（31.5 对 31.1kg/m2；P=.0001）；通过 Rate Your Plate，Heart 评估的饮食习惯（47.2 对 51.1；P<.05）。与 HBCR 参与相关的安全性问题很少。参与者非常满意。
VA HBCR 计划为广泛的患者提供了有力的有效性和安全性证据，包括那些临床复杂和风险较高的患者。HBCR 为基于地点的计划和获得心脏康复提供了补充。需要进一步研究来评估该模型的长期效果、成本效益和可持续性。
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