Patient Characteristics and Outcomes Associated With Home-Based Cardiac Rehabilitation

BACKGROUND: Referrals to and participation in cardiac rehabilitation programs remain suboptimal. We examined factors associated with home-based cardiac rehabilitation (HBCR) referral and participation and associations of referral and participation with outcomes. METHODS: In this retrospective cohort study, we included adults ≥18 years of age from Kaiser Permanente Southern California with a HBCR-qualifying event or procedure between January 2021 and September 2024. HBCR referral and, separately, participation was identified within 90 days. Outcomes included 30-, 180-, and 365-day hospitalizations and all-cause mortality. RESULTS: Among 44 468 adults, 13 164 (29.6%) received a referral within 90 days. Those receiving versus not receiving a referral were younger (mean age 65.6 versus 70.6 years) and more often male (71.4% versus 59.5%). Referral was associated with a lower likelihood of 180-day all-cause and cardiovascular disease hospitalization (prevalence ratio [PR], 0.86 [95% CI, 0.82-0.91] and PR, 0.76 [95% CI, 0.66-0.82]), and 365-day all-cause and cardiovascular disease hospitalization (PR, 0.83 [95% CI, 0.79-0.86] and PR, 0.70 [95% CI, 0.66-0.75]). Participation was associated with a lower likelihood of 30-day all-cause hospitalization (PR, 0.78 [95% CI, 0.66-0.92]), 180-day all-cause and cardiovascular disease hospitalization (PR, 0.83 [95% CI, 0.75-0.91] and PR, 0.85 [95% CI, 0.74-0.98]), and 365-day all-cause and cardiovascular disease hospitalization (PR, 0.89 [95% CI, 0.82-0.96] and PR, 0.87 [95% CI, 0.78-0.98]). CONCLUSIONS: Older adults and women had lower HBCR referral highlighting persistent gaps. Lower hospitalization risk associated with timely HBCR referral and participation underscores the importance of appropriate patient screening to improve outcomes.