Patient preferences for home-based versus hospital-based cardiac rehabilitation.

The efficacy of hospital-based cardiac rehabilitation (CR) in the domains of mortality, morbidity, quality of life, health behavior change, risk reduction, and psychosocial well-being has been well established. 1-3 However, because of financial constraints, physician referral practices, geographic and transportation barriers, and patient preferences, access to CR services is suboptima1.4-8 Cardiac rehabilitation programs and policymakers alike have been looking to alternative models of service delivery to reduce cost and reach a greater number of patients, while continuing to provide effective programming.9 The delivery of home-based programs is now growing,lO and evidence does support its equivalent impact on exercise tolerance, lipid profile, systolic blood pressure, and psychosocial well-being when compared to traditional hospital-based programs. 1l-14 Home-based programs are also shown to be as safe and more cost-effective than as hospital-based CR programs. 15-17 Whereas patient preferences for hospital-based CR programs have been examined,18,19 preferences for home-based programs have not. The literature suggests several factors, which may affect patient preferences for these programs. First, women may prefer home-based programs to minimize travel time, distance, and transportation barriers,20,21 Second, women demonstrate improvements in both exercise capacity and lipid profile following homeand hospital-based CRll although evidence also suggests that women may not fare as well as men in home-based programs, with lower exercise adherence, cardiac knowledge, and stress management.22 Finally, the literature also suggests that older cardiac patients, in general, may prefer home-based services. 20,23 In that women tend to be older at the time of their entry into CR, this may be of particular importance. The objective of this study was to compare patient preferences for home-based versus hospitalbased CR programs.