Article

Cardiac rehabilitation (CR) is most often provided in a hospital setting.
Home-based models of care have been developed to overcome geographic, among
other, barriers in patients at a lower risk. This study assessed whether clinical
and geographic factors were related to the use of either a hospital-based or a
home-based program. Secondary analysis was undertaken within a study of 1268
cardiac outpatients recruited from 97 cardiologist practices where clinical data
were extracted. Participants completed a survey including the Duke Activity
Status Index. They reported CR utilization in a second survey mailed 9 months
later, including CR site and program model. Geographic information systems were
used to determine the distances and the drive times to the CR site attended from
patients' homes. Overall, 469 (37.0%) participants attended CR at one of 41
programs. Of the 373 (79.5%) participants with complete geographic data, 43
(11.5%) reported attending home-based CR. The sole clinical difference was in
activity status, where patients attending a hospital-based program had lower
activity status (P<0.01). There were no differences in model attended on the
basis of geographic parameters including urban versus rural dwelling or drive
times (P>0.05). In conclusion, only one-tenth of outpatients participated in a
home-based program, and this allocation was unrelated to geographic
considerations. Although patients should continue to be appropriately triaged on
the basis of clinical risk to ensure safety, more targeted allocation of patients
to home-based services may be warranted. This may optimize the degree of
participation and potentially patient outcomes.

Langue : ANGLAIS