Cardiovascular disease remains the leading cause of death in the US, with estimated annual costs of $503.2 billion. In 2012, approximately 17.5 million people died from cardiovascular diseases. Cardiac rehabilitation optimizes patient health and is effective in controlling symptoms, halting disease progression, and enhancing quality of life. In comparison to usual care, cardiac rehabilitation demonstrated a reduction in overall mortality of 20% and of cardiac mortality of 26% over 3 years. Patients who attend cardiac rehabilitation significantly reduce their risk of hospital readmission.
Despite the proven effectiveness of cardiac rehabilitation and the positive correlation between attendance at outpatient cardiac rehabilitation and reductions in mortality, participation rates at outpatient cardiac rehabilitation centers remain low, averaging nationally between 14- 31%. Barriers to attendance include low number of rehabilitation units, lack of access, parking issues, dislike of groups, and work or domestic commitments.
The restoration achieved from an inpatient stay may dissipate when patients are discharged from the hospital. Many cardiac patients discharged from the hospital are defined as homebound, meaning they are unable to leave their homes unassisted, and therefore, are unable to attend outpatient cardiac rehabilitation for several weeks to receive care specialized for their condition. Furthermore, CMS policy for cardiac rehabilitation mandates systolic heart failure patients with specific criteria can only attend outpatient cardiac rehabilitation six weeks after hospitalization. Because of this gap in cardiac care, patients may not receive specialized cardiac care for several weeks, inhibiting their ability to optimize their health condition for the rigors of outpatient cardiac rehabilitation and integration into the community.
In general, one in five patients discharged from the hospital experience an adverse event within three weeks. Home care clinicians lack training opportunities for specialized cardiac competencies, and therefore, have a limited ability to deliver specialized cardiac rehabilitative care to patients. Preliminary studies have demonstrated that there are superior rates of adherence to home-based rehabilitation, in comparison to center-based rehabilitation, and that offering a choice of rehabilitation settings can improve current low uptake, specifically with elderly and minority patients. Despite the increasing importance of the transition from hospital to community settings and the potential impact of home-based rehabilitation, there is currently no defined link in care standards among inpatient cardiac rehabilitation, home care, and outpatient cardiac rehabilitation.