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Study Shows Feasibility of Adapting Cardiac Rehabilitation for Home Care

After a patient is discharged from the hospital for treatment of cardiovascular disease, cardiac rehabilitation (CR) is often prescribed because these programs are proven to reduce mortality and risk of hospital readmission. However, only 14 percent of patients who have had a heart attack and 31 percent of patients who underwent coronary artery bypass graft surgery attend CR post-hospitalization.

There are a variety of patient- and system-based barriers inhibiting patient access to CR services, such as lack of facilities in close proximities to patients’ homes, inability to travel or drive, lack of provider referral, socioeconomic barriers, lack of knowledge about CR, and depression. For patients who do attend CR, there is an average wait time from hospital discharge to outpatient CR enrollment of approximately 35 days, resulting in a gap in specialized cardiac care for patients when functional decline and uncontrolled symptoms can occur.

With the support of the University of Pennsylvania President’s Engagement Prize (PEP) and the University of Pennsylvania School of Nursing (Penn Nursing), Jodi L. Feinberg, Nu’15, and her mentor Terri Lipman, PhD, CRNP, FAAN, the Miriam Stirl Endowed Term Professor of Nutrition at Penn Nursing and the Assistant Dean for Community Engagement, investigated the feasibility of incorporating CR into the home care setting to increase access to adapted programs, particularly among elderly patients. Their findings have recently been published in the journal Geriatric Nursing.

Their research evaluated the feasibility and acceptability of Feinberg’s Home Heart Health (HHH) – developed from the PEP funding and support she received – program among patients and clinicians. HHH is an interdisciplinary CR program adapted for home care that emphasizes cardiovascular disease risk factor modification for home care patients. Patients received home visits from trained nurses, physical therapists, and occupational therapists, who collaboratively provided an exercise plan, nutrition counseling, and self- management education, with accompanying patient teaching tools.

“There is evidence to support that home-based and center-based CR are equally effective in improving clinical outcomes, yet most home care agencies have yet to offer structured CR programs within their practice due to a lack of reimbursement mechanism and logistical challenges of incorporating CR within the limitations of a home care episode,” said Feinberg, RN, BSN, the study’s lead investigator. The study indicated that the HHH program represents a novel and feasible approach to increasing access to and utilization of CR services for elderly patients within a certified home health agency.

“As patient care continues to expand to the home and community settings, coupled with efforts to meet patients where they are, studies evaluating alternative methods of care delivery are vital,” said co-author Lipman.

Co-investigators also include: Kathryn H. Bowles, PhD, RN, FAAN; Ana Mola, PhD, RN, ANP-C, of NYU Langone Health; David Russell, PhD and Melissa Trachtenberg, both of the Visiting Nurse Service of New York; and Irene Bick, RN, MBA, of the School of Nursing at Columbia University.