Home-based telerehabilitation after CABG: higher objectively verified adherence and 12-week functional outcomes in a single-center observational cohort

Abstract

Home-based telerehabilitation (HBTCR) may address access barriers to center-based cardiac rehabilitation (CBCR) after coronary artery bypass grafting (CABG). However, real-world comparative evidence on objectively verified adherence and functional recovery, with careful confounding control, remains sparse. This observational cohort study compared session completion and 12-week functional outcomes between HBTCR and CBCR in post-CABG patients using routine clinical data. This single-center observational cohort screened 288 patients and identified 195 potentially eligible post-CABG patients (February 2024–February 2025). After excluding 28 patients with unresolved rehabilitation exposure, 167 patients (56 HBTCR, 54 CBCR, 57 usual care) formed the propensity-score estimation cohort, adjusted for 25 baseline covariates with generalized propensity scores and overlap weighting. The primary complete-case analysis included 105 patients (35 per group) with complete 12-week follow-up. The primary outcome was objectively verified session completion (% of 36 prescribed sessions). The key clinical outcome was 12-week VO 2 peak, analyzed via weighted ANCOVA. Results are reported as adjusted differences with 95% CIs. After weighting, covariates were well balanced (all SMDs <0.10). HBTCR showed significantly higher objectively verified session completion than CBCR (87.7% vs. 78.5%; overlap-weighted difference 9.1 percentage points, 95% CI: 4.4 to 13.7; P  < 0.001). The adjusted HBTCR–CBCR difference in 12-week VO 2 peak was small and not statistically significant (0.17 mL/kg/min, 95% CI: −0.50 to 0.84; P  = 0.616). Both active rehabilitation groups showed substantially larger 12-week VO 2 peak gains than usual care (adjusted differences >4.0 mL/kg/min). Among post-CABG patients who chose HBTCR or CBCR in routine practice, those choosing HBTCR had higher objectively verified session completion and comparable observed 12-week improvement in VO 2 peak. These findings support HBTCR as a feasible option for patients who prefer or require home-based rehabilitation because of work, travel, or scheduling constraints. Formal equivalence was not tested, and the clinical meaningfulness and cost-effectiveness of this delivery model warrant further evaluation.