Abstract Body (Do not enter title and authors here): Introduction: Despite robust evidence supporting improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underutilized. Virtual cardiac rehab (VCR) has been proposed as an alternative to traditional center-based CR (CBCR) to improve utilization rates. However, data supporting VCR efficacy and cost-effectiveness are lacking. In this study, we compared outcomes and cost of VCR vs. traditional CBCR.
Methods: This retrospective cohort study compared VCR vs CBCR for Geisinger Health System, which primarily serves patients in rural Pennsylvania. CBCR data were collected from January 2018 to September 2023 and VCR data were collected from July 2021 to September 2023. Propensity scores were used to weight the observations and health outcomes were assessed using a weighted time-to-event analysis. Primary health outcomes measured were 1-year mortality rates, recurrent MI, all-cause hospital readmission, and emergency department visits, expressed as the incident rate ratio (IRR) of VCR:CBCR. Primary cost outcomes were analyzed as cost ratios of VCR:CBCR assessing total medical costs allowed, pharmacy costs, and total costs of care over the 12 months post-CR enrollment, while address data were used to compare the two modalities’ geographic footprints.
Results: There were 3006 CR participants with mean age 67.7 years with 1017 (33.8%) women and 2924 (97.9%) white. A total of 2303 patients were enrolled in CBCR (76.6%) and 703 in VCR (23.4%). The VCR group was significantly older and had a significantly higher percentage of comorbidities including heart failure, diabetes and chronic pulmonary disease.
Compared to CBCR, VCR was associated with a significant reduction in 1-year all-cause hospital readmission (IRR=0.616, p<0.001) and 1-year ED admission (IRR=0.557, p<0.001). The IRR of MI and all-cause mortality did not significantly differ between VCR and CBCR. In addition, VCR was associated with significant reductions in medically related (cost ratio=0.814, p=0.0144) and total costs (cost ratio=0.838, p=0.0176) in the year following initiation of CR.
Conclusions: To our knowledge, the present study is the first to demonstrate both improvements in clinical efficacy and cost of VCR compared to CBCR. While this study’s retrospective design has limitations, it supports VCR as a viable addition to CBCR with at least comparable efficacy and cost, and as such, represents a key mechanism for improving access to and participation in CR for eligible patients.