Results Summary

What was the research about?

Doctors often recommend cardiac rehabilitation, or CR, for patients who have been in the hospital for heart problems, such as a heart attack. CR programs include exercise, changes in diet, and avoiding behaviors like smoking. CR can help prevent future heart problems.

CR programs usually take place in clinics. But patients may find it hard to go to the clinic for CR two or three times a week. Having CR at home may be easier.

In this study, the research team compared two types of CR programs:

  • Home CR. Patients exercised at home and checked their blood pressure and heart rate. A clinic staff member called once a week to check patients’ health, provide coaching, and give information about diet and exercise.
  • Facility CR. Patients visited a clinic two or three times a week to exercise under a staff member’s supervision. They also received information on diet and exercise.

The research team looked at how the two CR programs affected the distance patients could walk in a short time. Walking tests are a way to measure heart health.

What were the results?

After three months, compared with patients in facility CR, patients in home CR could walk further in six minutes. They also had more improvement than patients in facility CR in quality of life, physical activity, and symptoms of anxiety.

But patients in facility CR felt more confident in their ability to exercise and had more improvement in their memory and reasoning than patients in home CR.

After six months, each group had similar improvement in walking distance.

Who was in the study?

The study included 235 patients who received care for heart problems at one of three Veterans Affairs, or VA, medical centers. The average age was 65, and 99 percent were men. Of those in home-based CR, 78 percent were white, 11 percent were black, and 9 percent were Hispanic. Of those in facility-based CR, 77 percent were white, 19 percent were black, and 2 percent were Hispanic.

What did the research team do?

Patients receiving care at the San Francisco VA received home CR. Patients receiving care at the Pittsburgh and Ann Arbor VAs received facility CR. After three and six months, medical center staff tested patients to see how far they could walk in six minutes. Patients also filled out surveys about their health at three months.

Patients, patient advocates, healthcare providers, policy makers, and community members gave input on the study.

What were the limits of the study?

Doctors at the three VAs used different ways to refer patients for CR. This difference could have affected whether patients joined the study. At six months, 72 percent of patients in home CR and 39 percent of patients in facility CR left the study. Results may have differed if more patients had stayed in the study.

Future research could study patients’ health over the long term after CR.

How can people use the results?

Medical centers can use these results when considering what kind of CR to offer patients with heart problems.

Final Research Report

View this project's final research report.

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Peer-Review Summary 

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers commented on the presence of multiple differences among the three study sites that could have affected study outcomes, differences that went beyond the fact that one site offered home-based rehabilitation services and the two other sites offered facility-based rehabilitation services. The researchers added Table 1 to clarify the differences across the intervention sites and explained the reasons for some of the differences.
  • Among the differences across sites, reviewers noted differences in the average time between clinical events and the initiation of rehabilitation services, suggesting that the analyses control for these differences. The researchers clarified that the shorter time between the clinical event and rehab initiation is an important outcome of the study rather than a difference in the interventions. They also added a multivariable model, (Table 9, Model 3) that did control for number of days to enrollment.
  • Reviewers noted that patients dropping out of the study undermined the value of the longest follow-up interval, 6 months. The researchers acknowledged that this was a limitation of the study despite their best efforts to retain participants. However, the researchers also noted that since there were no differences in baseline characteristics between the participants who were and were not lost to follow up at 6 months, there was no reason to believe that patients who dropped out were either sicker or more functionally impaired than those who remained in the study.

Conflict of Interest Disclosures

The Conflict of Interest Disclosures for this project will be posted here soon.

Journal Citations

Related Journal Citations

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers commented on the presence of multiple differences among the three study sites that could have affected study outcomes, differences that went beyond the fact that one site offered home-based rehabilitation services and the two other sites offered facility-based rehabilitation services. The researchers added Table 1 to clarify the differences across the intervention sites and explained the reasons for some of the differences.
  • Among the differences across sites, reviewers noted differences in the average time between clinical events and the initiation of rehabilitation services, suggesting that the analyses control for these differences. The researchers clarified that the shorter time between the clinical event and rehab initiation is an important outcome of the study rather than a difference in the interventions. They also added a multivariable model, (Table 9, Model 3) that did control for number of days to enrollment.
  • Reviewers noted that patients dropping out of the study undermined the value of the longest follow-up interval, 6 months. The researchers acknowledged that this was a limitation of the study despite their best efforts to retain participants. However, the researchers also noted that since there were no differences in baseline characteristics between the participants who were and were not lost to follow up at 6 months, there was no reason to believe that patients who dropped out were either sicker or more functionally impaired than those who remained in the study.

Project Information

Mary Whooley, MD
University of California San Francisco
$1,932,960
10.25302/05.2020.IH.13046787

Key Dates

46 months
September 2013
April 2019
2013
2019

Study Registration Information

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Last updated: October 20, 2021