Retrospective Comparison of Outcomes and Cost of Virtual Versus Center-Based Cardiac Rehabilitation Programs.

Autor: Shah ND; Heart and Vascular Institute Danville PA USA., Banta CW; Heart and Vascular Institute Danville PA USA., Berger AL; Biostatistics Core, Geisinger Danville PA USA., Hattenberger A; Data Core, Geisinger Danville PA USA., Zimmerman A; Heart and Vascular Institute Danville PA USA., Martin BE; Heart and Vascular Institute Danville PA USA., Wu E; Recora New York NY USA., Majumdar U; Icahn School of Medicine at Mt Sinai New York NY USA., Kirchner HL; Department of Population Health Sciences, Geisinger Danville PA USA., Matsumura ME; Heart and Vascular Institute Danville PA USA.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Dec 17; Vol. 13 (24), pp. e036861. Date of Electronic Publication: 2024 Dec 14.
DOI: 10.1161/JAHA.124.036861
Abstrakt: Background: Despite robust evidence supporting an association with improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underused, with a minority of eligible patients participating. Virtual cardiac rehabilitation (VCR) has been proposed as an alternative to traditional center-based CR (CBCR) to improve usage rates. However, data supporting the efficacy and cost-effectiveness of VCR are limited. In the present study, we compared the outcomes and cost of a VCR versus traditional CBCR program.
Methods and Results: In a retrospective cohort study comparing VCR versus CBCR, CBCR data were collected from a period of January 2018 to September 2023. VCR data were collected from program initiation in July 2021 to September 2023. Primary health outcomes measured were 1-year mortality rates, recurrent myocardial infarction, all-cause hospital readmission, and emergency department visits. Primary cost outcomes were analyzed as cost ratios related to VCR versus CBCR assessing total medical costs allowed, pharmacy costs, and total costs of care over the 12 months post-CR enrollment. VCR was associated with a significant reduction in 1-year all-cause hospital readmission (incident rate ratio [IRR], 0.616 [95% CI, 0.489-0.777], P <0.001) and ED admission (IRR, 0.557 [95% CI, 0.452-0.687], P <0.001) at 1 year. The IRR of myocardial infarction and all-cause mortality did not significantly differ between VCR and CBCR. In addition, VCR was associated with significant reductions in medically related (cost ratio, 0.814 [95% CI, 0.690-0.960], P =0.0144) and total costs allowed (cost ratio, 0.838 [95% CI, 0.725-0.970], P =0.0176).
Conclusions: VCR is a viable alternative to CBCR with at least comparable efficacy and cost, and as such, represents a key mechanism for improving access to and participation in CR for eligible patients.
Databáze: MEDLINE
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