Home-Based Cardiac Rehabilitation Linked to Higher Participation Among US Veterans

Key Takeaways

• Cardiac rehabilitation (CR) participation among US veterans with ischemic heart disease (IHD) increased from 9.6% in 2012 to 17.1% in 2022, according to a US Veterans Health Administration (VHA) cohort study.
• Veterans treated at facilities offering home-based cardiac rehabilitation (HBCR) had 80% higher adjusted odds of CR participation than those at facilities offering community care referrals only.
• Despite increased participation, fewer than 1 in 5 eligible veterans received CR, highlighting persistent gaps in access and utilization.

A national VHA cohort study involving more than 405 000 US veterans with IHD found that CR participation nearly doubled between 2012 and 2022. Facilities offering HBCR had higher participation rates than those offering center-based cardiac rehabilitation (CBCR) without HBCR or community care referrals only, suggesting that expanded rehabilitation delivery options may help address persistent barriers to care.

Cardiac Rehabilitation Participation Increased Over 10 Years

Researchers analyzed national VHA electronic health record data from 405 907 veterans hospitalized for IHD between 2012 and 2022. Participants had experienced acute myocardial infarction, undergone percutaneous coronary intervention, or received coronary artery bypass graft surgery.

The mean age was 68.5 years, and 96.6% were men. Overall, 63 185 veterans (15.6%) participated in at least 1 CR session within 12 months of their qualifying cardiovascular event.

CR participation increased from 9.6% in 2012 to 17.1% in 2022, peaking at 19.7% in 2018 before declining beginning in 2020.

In 2022, participation differed by facility rehabilitation offerings:

• HBCR available: 20.0%
• CBCR available without HBCR: 14.8%
• Community care referrals only: 14.3%

Compared with facilities offering community care referrals only, facilities providing HBCR were associated with 80% higher adjusted odds of CR participation (adjusted odds ratio [AOR], 1.80; 95% CI, 1.75-1.84).

Facilities offering CBCR without HBCR also demonstrated higher participation (AOR, 1.29; 95% CI, 1.26-1.32).

Persistent Disparities Highlight Opportunities to Expand Access

Although CR participation increased, the findings demonstrate continued underutilization of guideline-recommended secondary prevention services among veterans with IHD.

Veterans who participated were more likely to be younger, male, White, married, and of higher socioeconomic status. Lower participation among older veterans, women, racially minoritized populations, and individuals with lower incomes highlighted persistent disparities.

The researchers identified transportation challenges, geographic distance, competing responsibilities, and physical limitations as potential barriers to traditional CBCR.

Flexible HBCR programs may help address these barriers, particularly for veterans who cannot regularly attend facility-based sessions.

However, the observational findings do not establish causality. Researchers could not determine which rehabilitation model individual veterans used, and differences in staffing, referral practices, or institutional resources may have influenced participation.

Researchers Call for More Accessible Rehabilitation Models

The study authors emphasized that broader availability of HBCR may help close gaps in rehabilitation utilization across the VA health system.

They recommended evaluating flexible delivery approaches alongside targeted outreach, clinician education, peer support, and digital engagement strategies.

The authors also called for prospective research examining patient-, clinician-, and health system–level factors influencing rehabilitation enrollment, participation, completion, and long-term maintenance.

Overall, the findings suggest that expanding HBCR availability may support greater CR participation among US veterans with IHD. However, persistent disparities and low overall utilization underscore the need for additional strategies to improve equitable access to cardiovascular secondary prevention services.

Reference

Park LG, Zhang N, Schopfer DW, et al. JAMA Netw Open. 2026;9(10):e2638356. doi:10.1001/jamanetworkopen.2026.38356