Assessing impact of home-based digital cardiac rehabilitation on readmissions and patient outcomes following step-down from the acute heart failure virtual ward

Abstract Background Heart Failure (HF) Virtual Wards (HFVW) enable patients with acute HF to be managed in their own homes with digital health technology enabled care by HF specialist teams instead of hospitalization. Cardiac rehabilitation (CR) improves clinical outcomes, however, UK HF audit data indicates that only 5-10% HF patients undergo CR. Purpose We conducted a real-world service improvement evaluation to examine the feasibility and outcomes of a novel digital CR service as a step-down from acute HFVW. Methods Patients on the Acute HFVW received a pre-discharge visit from a specialist HF nurse during which suitable patients were consented for home CR to be started 2 weeks following discharge. Other than standard clinical exclusion criteria for CR, an additional exclusion criterion was lack of access to a smartphone/tablet. Patients received a proprietary, wrist-worn physical activity (PA) monitor to assess minute-level energy expenditure, access to a personalised, interactive online dashboard, and 6x20 minute phone calls across a 12-week period from a trained Mentor to support self-care. Readmissions were assessed at 30-day, 90-day timepoints, and compared to standard care. Further quantitative measures included uptake and adherence, change in objective PA dose, and change in patient reported outcome measures (PROMs) for Quality of Life (QoL), Mental Wellbeing, Self-Efficacy and Work and Social Adjustment Scale (WSAS) domains. Readmission rates were compared using non-parametric statistics (Chi squared test). Results From May 2024, 185 patients (median age 70, range 34-90y, 63% men) were referred to digital home CR from the acute HFVW and 116/185 patients (63%) took up the offer. Programme drop-out rate was 30%. Readmission rates were statistically significantly (p<0.001) lower in the home digital CR service at 30-day, 90-day timepoints in comparison to standard care (5% vs. 21%; and 9% versus 30% respectively). 78% of patients improved their everyday physical activity. On average, patients improved their daily PA dose by +31 minutes per day compared to week-1 blinded baseline, equating to an average additional PA dose of +32 hrs 32 mins per patient across the CR period. Furthermore, 58% of patients improved their QoL, 74% improved their Mental Wellbeing, and 69% improved their Self-Efficacy. With regards to the WSAS domains, 71% of patients improved their ability to work and 86% improved their overall score. Conclusion This is the first study to demonstrate feasibility of home digital CR following step-down from the acute HFVW. Lower readmission rates at 30-day and 90-day timepoints vs. standard care highlight potential for large healthcare cost-savings, which future economic analysis should validate. Uptake rates were six times greater than that for standard HF CR, with increased PA dose and other validated PROMs demonstrating patient impact and the potential benefits of the novel digital CR, following management in a specialist HFVW.