Home-Based Cardiac Rehabilitation: A SCIENTIFIC STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION, THE AMERICAN HEART ASSOCIATION, AND THE AMERICAN COLLEGE OF CARDIOLOGY.
Home-Based Cardiac Rehabilitation: A SCIENTIFIC STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION, THE AMERICAN HEART ASSOCIATION, AND THE AMERICAN COLLEGE OF CARDIOLOGY.
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DOI：
10.1097/hcr.0000000000000447
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发表时间：
2019-07
影响因子：
3.8
通讯作者：
Whooley MA
中科院分区：
文献类型：
--
作者：
Thomas RJ;Beatty AL;Beckie TM;Brewer LC;Brown TM;Forman DE;Franklin BA;Keteyian SJ;Kitzman DW;Regensteiner JG;Sanderson BK;Whooley MA
心脏康复(CR)是一种循证干预，它利用患者教育、健康行为矫正和运动训练来改善心血管疾病患者的二级预防结果。CR计划降低了患有缺血性心脏病、心力衰竭或心脏手术的成年人的发病率和死亡率，但在美国，只有少数符合条件的患者参与了CR。迫切需要新的交付战略来提高参与度。一种潜在的策略是基于家庭的CR(HBCR)。与在医疗监督设施中提供的基于中心的CR服务不同，HBCR依赖于具有间接锻炼监督的远程教练，并且主要或完全在传统的基于中心的设置之外提供。尽管HBCR已经在英国、加拿大和其他国家成功部署，但大多数美国医疗组织在此类项目方面几乎没有经验。这份科学声明的目的是确定核心组成部分、有效性、优势、局限性、证据差距和必要的研究，以指导HBCR在美国的未来实施。以前的随机试验已经产生了低到中等强度的证据，表明HBCR和基于中心的CR在3到12个月的临床结果中可以取得类似的改善。尽管HBCR似乎有希望将CR的使用扩大到符合条件的患者，但还需要更多的研究和示范项目来澄清、加强和扩大关键亚群的HBCR证据基础，包括老年人、妇女、代表性不足的少数群体以及其他风险较高和研究不足的群体。在此期间，我们得出结论，对于有资格接受CR但不能参加传统的以中心为基础的CR计划的临床稳定的低到中等风险患者来说，HBCR可能是一个合理的选择。
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low-to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.