What is the research about?
Cardiac rehabilitation is a program of exercise training and health behavior counseling for people with heart conditions. About 2 million people per year are eligible for cardiac rehabilitation in the United States. Most cardiac rehabilitation programs meet in person for 36 sessions over 12 weeks. Cardiac rehabilitation has been shown to help people live longer and healthier lives, but only one in four people who are eligible for cardiac rehabilitation attend even one session. Unfortunately, there are also disparities in who attends cardiac rehabilitation. Women, racial and ethnic minorities, and socioeconomically disadvantaged people are less likely to attend cardiac rehabilitation. There is urgent need for new approaches to expand access to and promote equitable participation in cardiac rehabilitation.
Some health systems have used telehealth (such as a telephone or video visit between a patient and a health professional) to deliver cardiac rehabilitation to make it more convenient for people who have difficulty going to a cardiac rehabilitation center. Small studies suggest telehealth cardiac rehabilitation may be just as safe and work as well as in-person cardiac rehabilitation in the short term. It is not known whether telehealth cardiac rehabilitation can improve disparities, and many populations weren’t included in previous studies. This research will answer the question: For diverse chronic heart disease patients, does telehealth cardiac rehabilitation, compared to in-person cardiac rehabilitation, result in similar or better patient-centered outcomes?
Who can this research help?
This research can help millions of people with heart conditions who are eligible for cardiac rehabilitation. This includes people who have had a heart attack, heart stent placement, heart bypass surgery, heart valve repair or replacement, or heart transplant or people who have chronic stable angina (chest pain) or chronic heart failure with low ejection fraction. It will help people decide whether to attend in-person or telehealth cardiac rehabilitation. It will also help health systems decide whether they should offer telehealth cardiac rehabilitation to their patients and how to best set up their program to help their patients.
What is the research team doing?
The research team is working with patients, providers, and researchers at four hospitals across the country to enroll 516 adults who are eligible for cardiac rehabilitation. First, the team will work with groups of patients to create telehealth cardiac rehabilitation program materials that are accessible to people with different needs and different levels of familiarity with telehealth. Second, the team will assign patients by chance to one of two groups: in-person cardiac rehabilitation or telehealth cardiac rehabilitation. Each group has equal numbers of patients.
Patients in the in-person cardiac rehabilitation group will receive traditional in-person cardiac rehabilitation at their local cardiac rehabilitation center. Patients in the telehealth cardiac rehabilitation group will receive cardiac rehabilitation delivered through telehealth, with video visits or phone calls with the cardiac rehabilitation team. The telehealth group will also have an optional mobile application to record their vital signs and physical activity. The research team will follow both groups for two years to see if there are differences between the groups in how well they function and how well they feel. The research team will also examine outcomes like blood pressure control and time spent alive and outside of the hospital.
This project was developed by a team that includes patient partners, caregivers, researchers, healthcare providers, healthcare administrators, health insurance providers, and professional society organizations. Patient partners are important since they have a special perspective into the needs of people with heart disease. They participate in study leadership team meetings and lead a patient advisory board to guide the research in a way that meets patients where they are to help improve their cardiovascular health.
Design: Randomized controlled trial
Population: 516 patients with heart disease who are eligible for cardiac rehabilitation, including older adults, women, and racial/ethnic minorities
- Telehealth cardiac rehabilitation
- In-person cardiac rehabilitation
- Primary: Quality of life, six-minute walk distance
- Secondary: Depressive symptoms, anxiety symptoms, blood pressure control, hospitalization-free survival
Timeframe: Up to two-year follow-up for outcomes
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.