Background: Despite proven benefits (reduced re-hospitalisation, morbidity and mortality), only 30–50% of eligible patients participate in cardiac rehabilitation (CR) programmes. Home-based CR programmes have been introduced in an attempt to widen access and participation. Similar to centre-based programmes, a number of research studies of different home-based CR models have reported improved patient outcomes. It is therefore supposed that home-based programmes can help fulfil an over-riding priority that–irrespective of gender, age, ethnicity, location, or social status–all patients can use secondary prevention services.
Purpose: A mobile health (m-Health) platform, developed to remotely deliver CR, was previously tested (through a randomised controlled trial) and demonstrated significantly better uptake and completion than, and equal clinical outcomes to that of traditional centre-based CR programmes. The current research aimed to evaluate real world implementation of this m-Health CR programme, through enabling the offering of a variety of tailored CR programme options.
Methods: Patients referred to three CR Services in Australia (Dec'16 to Oct'17) were allocated to a CR programme according to individual circumstances and choices. Centre-based, m-Health supported home-based, or hybrid programmes were offered as shown in the Figure.
Results: As at the end of recruitment, 359 eligible patients were offered CR at participating CR Services, with 26 persons failing to engage in their chosen programme. Uptake of the home-based and hybrid CR programmes was unexpectedly low, with two of the services reporting 6% and 7% participation in the home-based programme respectively, and none at the 3rd service. Only one service had five patients selecting to partake in the hybrid CR offering. Home-based patients were generally younger (58±9 years) than the centre-based (64±11 years). All CR programs were found to be effective, with improvement in functional capacity (6-Minute Walk Test) and Heart Quality of Life in all patients, albeit failing to reach statistical significance in the home-based programmes due to small sample size.
Discussion: Delivering a variety of CR programme options was envisaged to improve overall CR service use. However, even though overall participation increased to some extent, uptake of home-based programmes was lesser than anticipated, indicating lower than expected adoption. So, are we there yet? It seems not. Who/what do we blame? m-Health supported home-based CR programmes have been shown to overcome geographical barriers and improve patient health outcomes. Therefore, a conjugal between CR services and m-Health perhaps require not only a cultural shift, strong clinical leadership and management but also new skills and new ways of working and most of all, new funding models. Moreover, emerging ethical and regulatory concerns from the growing role that m-Health technologies are playing in home-based care need to be addressed.