大規模統合医療システムにおける在宅ベースの仮想心臓リハビリテーションの患者転帰

Cardiac rehabilitation can improve patient outcomes and reduce risk of recurrent cardiac events. Virtual home-based programs may support patient access and participation if feasible and effective. Among all eligible patients with a cardiac event (myocardial infarction [MI], coronary artery bypass graft [CABG], or percutaneous coronary intervention [PCI]) between 2016-2022, within a multi-site integrated delivery system offering a virtual home-based cardiac rehabilitation program, we examined the association between cardiac rehabilitation exposure and return emergency department (ED) visits or hospitalizations, MACE events, and revascularization during a 1 year period after rehabilitation, using propensity weighted multivariate analyses to balance rehabilitation and non-rehabilitation groups. Among 25,552 eligible patients across 21 medical centers, 7,077 (27.7%) enrolled in home-based virtual cardiac rehabilitation and received 3 or more intervention encounters. After adjustment, cardiac rehabilitation exposure was associated with higher risk of all-cause ED visits (Adjusted RR: 1.08, 95% CI: 1.05-1.12) and significantly lower risk of hospitalizations (Adjusted RR: 0.86, 95% CI: 0.81-0.90). We found no statistically significant association with MACE And revascularization events. Cardiac rehabilitation was, however, associated with a significantly lower rate of 1 year mortality (Adjusted RR: 0.68, 95% CI: 0.60-0.76). In conclusion, virtual home-based cardiac rehabilitation was associated with lower hospitalization and mortality, showing feasibility and effectiveness for improving cardiac outcomes. Further attention may be given to increasing patient engagement, given the relative convenience of a home-based virtual program.