New guide to home-based cardiac care is released

The health care landscape has undergone rapid changes in recent years, requiring clinicians and stakeholders to consider innovative ways to provide care in traditional and non-traditional settings. The American College of Cardiology has released a workbook on home-based cardiac care that provides the cardiovascular care team with tools and resources to incorporate high-quality, patient-centered care in the home setting.

Home-based care is defined as any form of medical care that takes place in the home of the patient; this includes the acceleration of virtual care seen during the COVID-19 pandemic due to increased consumer demand, clinician interest and regulatory changes. While other countries have integrated home-based care models into their health care system, the United States had a significant decline in house calls and home-based care after 1997 when benefits were capped to help control Medicare costs.

"While interest in and access to home-based care has grown considerably in the last few years, these services often remain underutilized, especially in the case of acute and specialty care," said Nivee P. Amin, MD, MHS, FACC, chair of the ACC Home-Based Care Workbook writing committee. "However, given the rise of chronic diseases like heart disease and many elderly people's desire to remain in their own homes as they age, it is vital that we look at every possibility for how to appropriately provide care at home. The ACC created this workbook in hopes that all stakeholders in this space might see the possibilities and benefits of increasing home-based care."

The workbook examines the full spectrum of what providing home-based cardiac care in the U.S. would look like, including:

• Advantages and disadvantages of basic and advanced cardiac care in the home
• Guiding principles and objectives for developing a home-based care program
• Key performance indicators to measure the success of home-based care programs

Other key areas the workbook covers include challenges related to home-based care, the scope of home-based health care, program considerations for home-based care and reimbursement.

According to the authors, there are numerous applications for home-based care in cardiovascular medicine and its use is likely to expand in the coming years. The workbook provides a general framework of clinical scenarios where the integration of home-based care may be impactful:

• Elective outpatient percutaneous coronary intervention and peripheral vascular intervention
• Cardiac implantable electronic device placement
• Electrophysiology catheter ablation
• Home care after an acute coronary syndrome or critical limb ischemia
• Chronic arrhythmia management
• Heart failure

"Many within the health care industry believe that cardiovascular care will be increasingly delivered in non-traditional ambulatory settings," Amin said. "The cardiovascular care community must consider and prepare for this eventuality. The ACC looks forward to leading this effort so that home-based care improves patient access and outcomes."