title: Feasibility and effectiveness of remote, telephone-based delivery of cardiac rehabilitation.
abstract: OBJECTIVE
  Cardiac rehabilitation (CR) provides significant benefit for persons with cardiovascular disease. However, access to CR services may be limited by driving distance, costs, need for a driver, time away from work, or being a family primary caregiver. The primary aim of the project was to test the reach (i.e., patient and provider uptake), effectiveness (safety and clinical outcomes), and implementation (time and costs) of a remote telephone-based Phase 2 CR program. A secondary aim was to compare outcomes between patients attending the remote program (home-CR) and those attending an on-site program (comparison group).
  
  
  METHODS
  Subjects were given a choice of the remote or face-to-face program. Remote CR participants (n=48) received education and assessment during 12 weekly by telephone calls. Data were compared with those for face-to-face CR program participants (n=14). Independent t tests and chi-squared tests were used for continuous and categorical variables, respectively. Repeated-measures analysis of covariance models were used to assess differences in outcomes. Costs were analyzed using a cost-minimization analysis.
  
  
  RESULTS
  Of 107 eligible patients, 45 refused participation, 5 dropped out, and 1 died unrelated to the study. Participants had a mean age of 64 (standard deviation 7.5) years. Remote CR participants were highly satisfied with their care and had a higher completion rate (89% of authorized sessions versus 73% of face-to-face). Costs for each program were comparable. There were no significant changes over time in any measured outcome between groups at 12 weeks except medication adherence, which decreased over time in both groups; face-to-face patients reported a greater decrease (p=0.05).
  
  
  CONCLUSIONS
  This is the first study to test a remote CR program in a population of older Veterans. Many hospitals do not provide comprehensive CR services on-site; thus remote CR is a viable alternative to bring services closer to the patient.
authors.affiliation: 1 Iowa City VA Healthcare System, Veterans Rural Health Resource Center-Central Region , VA Office of Rural Health, Iowa City, Iowa.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wakefield
authors.forename: Kariann
authors.initials: K
authors.lastname: Drwal
authors.forename: Melody
authors.initials: M
authors.lastname: Scherubel
authors.forename: Thomas
authors.initials: T
authors.lastname: Klobucar
authors.forename: Skyler
authors.initials: S
authors.lastname: Johnson
authors.forename: Peter
authors.initials: P
authors.lastname: Kaboli
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000534:rehabilitation*; D003365:Costs and Cost Analysis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D013689:Telephone; D013997:Time Factors