Center- vs Home-Based Cardiac Rehabilitation in Patients With Heart Failure: EXIT-HF Randomized Controlled Trial.

Abstract

Background: Despite being an evidence-based intervention, the implementation of cardiac rehabilitation (CR) is often unsatisfactory, especially among patients with heart failure (HF). Home-based CR can serve as an alternative to improve accessibility for patients unable to participate in center-based programs.

Objectives: The study sought to compare the clinical impact of center- vs home-based CR in HF patients.

Methods: Single-center, parallel group, noninferiority trial, enrolling HF patients irrespective of ejection fraction. Patients were randomly allocated in a 1:1 ratio, then adjusted to a 1 center/2 home ratio during the COVID-19 pandemic, then adjusted to 12 weeks of a standard center-based (24 supervised exercise sessions) or home-based CR (4 supervised sessions plus 20 sessions at home, asynchronously monitored by telephone using wearable smartwatch data) program. The primary outcome was change in peak oxygen uptake (Vo₂peak) at 12 weeks.

Results: Of the 120 patients (age 62 ± 11 years, 66% men, mean left ventricular ejection fraction 36 ± 11%) who were randomized to center-based (n = 45) or home-based (n = 75) CR, 95 (79%) had complete Vo₂peak data at the 12-week assessment: 34 (76%) in the center-based group and 61 (81%) in the home-based group. No significant between-group differences were found in Vo₂peak change from baseline to week 12 (0.8 mL/kg/min [95% CI: 1.8 to -0.16 mL/kg/min]; P = 0.10). Additionally, no between-group differences were found for changes in the prespecified secondary outcomes: 6-minute walking distance, Minnesota Living with Heart Failure Questionnaire scores, disease-related biomarkers, and physical fitness. Exercise adherence to the CR program was similar between groups (home-based 84% vs center-based 81%).

Conclusions: In a contemporary well-treated HF population, home-based CR was noninferior to the center-based program, supporting the home-based approach as an effective and feasible alternative to the traditional center-based programs. (EXercise InTervention in Heart Failure [EXIT-HF]; NCT04334603).