Background: Despite being an evidence-based intervention, the implementation of cardiac rehabilitation(CR) is often unsatisfactory, especially among patients with heart failure(HF).

Home-based CR can serve as an alternative to improve accessibility for patients unable to participate in center-based programs.

Objectives: To compare the clinical impact of a center-versus home-based CR in HF patients.

Methods: Single-center, parallel group, non-inferiority trial, enrolling HF patients irrespective of ejection fraction. Patients were randomly allocated in a 1:1 ratio, then adjusted to a 1 center/2 home ratio during the COVID-19 pandemic, to 12 weeks of standard centerbased (24 supervised exercise sessions) or home-based CR program (4 supervised sessions plus 20 sessions at home, asynchronously monitored by telephone using wearable smartwatch data). The primary outcome was change in peak oxygen uptake(VO2peak) at 12 weeks.

Of the 120 patients (age 62±11 years, 66% were men, and mean LVEF was 36±11%) who were randomized to center-based(n=45) or home-based CR(n=75), 95(79%) had complete VO2peak data at the 12-week assessment: 34(76%) of center-based and 61(81%) of home-based group. No significant between-group differences were found in VO2peak change from baseline to week 12 (0.8 mL/kg/min, 95%CI: 1.8 to-0.16, p=0.10).

Additionally, no between-group differences were found for changes in the prespecified secondary outcomes: 6MWD, MLHFQ scores, disease-related biomarkers, and physical fitness. Exercise adherence to the CR program was similar between groups (home-based:84% vs. center-based:81%).

In a contemporary well-treated HF population, home-based CR was noninferior to center-based program, supporting the home-based approach as an effective and feasible alternative to the traditional center-based programs.