Effectiveness of a Hybrid Cardiac Rehabilitation Program: A PRAGMATIC RANDOMIZED CONTROLLED TRIAL

Purpose: Evaluate the effectiveness of a hybrid cardiac rehabilitation (CR) program compared with a traditional CR program and to assess the long-term effectiveness of the hybrid program in terms of promoting improvements in physical activity, functional capacity, health-related quality of life (HRQoL), and symptoms of anxiety and depression. Methods: A pragmatic randomized clinical trial was conducted across nine centers. The traditional program involved in-center exercise sessions twice a week for 12 weeks. The hybrid program included in-center sessions twice a week for 6 weeks, followed by a gradual replacement of in-center sessions by home-based sessions over the next 6 weeks. Physical activity levels, functional capacity, HRQoL, and symptoms of anxiety and depression were assessed at baseline, at the end of the program, and at a 6-month follow-up. A generalized linear mixed model was used to assess between-group differences. Results: Of the 295 participants recruited, 224 completed the end-of-program assessment (76%), and 169 were followed up at 6 months (57%). There were no statistically significant differences between the groups for all variables except for HRQoL. Between baseline and discharge, both groups showed significant improvements in all variables. At 6 months, no significant changes or differences between groups were found, indicating that the benefits were maintained over time. Conclusions: No statistically significant differences were observed between groups for most outcomes. Both hybrid and traditional CR programs led to significant improvements in all outcomes. These benefits were sustained 6 months after completing either type of program.