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Outpatient Cardiac Rehab Proves Safe The Latest Systematic Review

Less than a third of Australians commence cardiac rehabilitation as needed, and a small percentage of those demonstrate adherence throughout their individualised programmes.1,2 This results in avoidable morbidity and mortality.

Reviews have suggested the following factors contribute to low adherence rates: lack of referral, reimbursement, perceived benefits, long drives, occupation, and more.2 Did you know exercise physiology at Advanced Physiotherapy helps make us a trusted referral for cardiac rehabilitation while helping prescribers overcome some of the barriers to patient adherence?

Open twelve hours per day, and offering a low-cost patient-only gym, our convenient hours make rehab and self-directed exercise accessible to people working various schedules. What’s more, as an outpatient provider, our costs are often lower, resulting in lower co-pays for patients. Finally, our location may be more convenient for some of your patients.

Cardiovascular diseases rank as the leading cause of death by category and the most common hospital admission.3 Fortunately, cardiac rehabilitation accelerates recovery, reduces mortality, and cuts hospitalisation risk.4 At Advanced Physiotherapy, this practical, evidence-based, professionally supervised treatment approach combines patient assessments, physical activity counselling, exercise training, and general guidance regarding nutrition, risk factor modification (management of lipids, blood pressure, weight, diabetes, smoking), psychosocial management, and other components.

Embracing more sites for care has been proposed as one remedy for low cardiac rehab rates. Various studies have demonstrated the effectiveness of different outpatient settings, community-based settings, and even telehealth.5 However, in clinical practice during COVID, many of us experienced how patients often have trouble with telehealth technology. Additionally, concerns over patient safety may be one barrier to doctors offering cardiac rehabilitation in various settings.

Therefore, Stefanakis et al. undertook a first-of-its-kind study directly measuring safety of home-based cardiac rehab (HCBR) delivered by telehealth. The review includes nine randomised, controlled trials covering more than 800 patients. These patients had varied condition severity, and six studies included high-risk patients. Researchers found one severe adverse event (AE) per 23,823 patient-hours of rehabilitation. For comparison, the rate of adverse events in centre-based cardiac rehab is 1 per 48,565 patient-hours.

Researchers report a notably lower incidence of exercise-related AEs among HCBR patients who were individually assessed with baseline cardiopulmonary exercise testing and given an individual exercise plan. The authors of the current study also note that some interventions had real-time telehealth supervision, while others only had post-exercise telemonitoring, theorising that more immediate supervision can further increase cardiac rehab safety.

Researchers conclude that even telemonitored, home-based rehabilitation proves equally safe and that it should be considered as a tool for improving patient uptake of cardiac rehabilitation for disease and following acute myocardial infarction, cardiac revascularisation, or heart failure. As the study authors suggest, we prefer direct patient contact; thorough preliminary evaluations; individualised care planning; and real-time professional supervision. We cite the work of Setanakis et al. to demonstrate the overall safety of cardiac rehabilitation and how referring to an outpatient clinic, as well as other settings, may improve uptake of cardiac rehab.


1. Driscoll A, Hinde S, Harrison A, Bojke L, Doherty P. Estimating the health loss due to poor engagement with cardiac rehabilitation in Australia. International Journal of Cardiology. 2020 Oct 15;317:7-12.

2. Daly J, Sindone AP, Thompson DR, Hancock K, Chang E, Davidson P. Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review. Progress in Cardiovascular Nursing. 2002 Jan;17(1):8-17.

3. Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved?. Integrated Pharmacy Research and Practice. 2019 Feb 4:1-1.

4. Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. European Heart Journal. 2023 Feb 7;44 (6):452-69.

5. Thomas EE, Cartledge S, Murphy B, Abell B, Gallagher R, Astley C, Australian Cardiac Rehabilitation COVID-19 Impact Group Cameron Jan Jackson Alun Ferry Cate Bourne Carmel Gray Kim McIvor Dawn Inglis Sally Storen Anna Sanderson Sue Zecchin Robert Verdicchio Christian. Expanding access to telehealth in Australian cardiac rehabilitation services: A national survey of barriers, enablers, and uptake. European Heart Journal-Digital Health. 2023 Oct 3:ztad055.

6. Stefanakis M, Batalik L, Antoniou V, Pepera G. Safety of home-based cardiac rehabilitation: a systematic review. Heart & Lung. 2022 Sep 1;55:117-2

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