Cardiac rehabilitation after myocardial infarction: a comparison between the standard and home-based cardiac rehabilitation programs

Abstract

Background: Cardiovascular disease (CVD) has emerged as the leading cause of death worldwide. Multiple meta-analyses have demonstrated that cardiac rehabilitation (CR) reduces mortality in patients with coronary artery disease. Despite guidelines recommending the use of CR programs for patients with ST segment elevation myocardial infarction (STEMI) participation in these programs continues to be low which had led to the development of alternative models of CR. Objective: To evaluate the efficacy of home-based cardiac rehabilitation (HBCR) program in patients presenting with STEMI in a comparison with the standard in-hospital CR program. Methods: The study included 70 Patients referred for cardiac rehabilitation unit at Ain shams university hospitals after STEMI successfully treated by primary PCI. Patients were subdivided into two (2) groups according to patients’ preference to different modalities of cardiac rehabilitation: Group (A): 35 patients who underwent regular in-hospital cardiac rehabilitation Group (B): 35 patients who couldn’t undergo regular in-hospital cardiac rehabilitation and preferred to undergo home-based cardiac rehabilitation Outcome measures were assessed at baseline and after completion of the CR program in the form of: 12 hr fasting lipid profile (TC, HDL, LDL and TGs). Transthoracic echocardiographic examination for assessment of Ejection fraction (EF%) by 2D modified biplane Simpson's method Symptom limited treadmill exercise stress test using Modified Bruce protocol: The following parameters were recorded: Resting blood pressure, resting heart rate (HR) and maximum achieved HR, HR recovery at 1 minute (HRR1), HR reserve and metabolic equivalents of task (METs) achieved. Results: No significant differences between both groups regarding baseline lipid profile, EF% and Exercise test parameters before starting the CR program. There was a statistically significant improvement in Lipid profile, EF% and Exercise test parameters (METs, Exercise time, peak HR, HR reserve and HRR) after completion of the CR program in both groups with no statistically significant difference between both groups regarding delta changes in the studied parameters. Conclusion: Home-based cardiac rehabilitation does not have inferior outcomes compared to hospital-based supervised program in post MI patients and may offer an alternative model of CR for individuals less able to access center-based cardiac rehabilitation.