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Cited by 623Cardiac Health and Mental HealthCardiovascular and exercise physiologyMedical Practices and Rehabilitation

Home-based versus centre-based cardiac rehabilitation

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Taylor, Rod S, Dalal, Hayes, Jolly, Kate, Moxham, Tiffany, Zawada, Anna·2010·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd007130.pub2PMC PMC4160096
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Abstract

BACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. OBJECTIVES: To compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials, including parallel group, cross-over or quasi-randomised designs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all identified references for inclusion based on pre-defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. MAIN RESULTS: We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in clinical primary outcomes up to 12 months of follow up: total mortality (relative risk (RR) = 1.19, 95% CI 0.65 to 2.16; participants = 1505; studies = 11/comparisons = 13; very low quality evidence), exercise capacity (standardised mean difference (SMD) = -0.13, 95% CI -0.28 to 0.02; participants = 2255; studies = 22/comparisons = 26; low quality evidence), or health-related quality of life up to 24 months (not estimable). Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate quality evidence). However, there was evidence of marginally higher levels of programme completion (RR 1.04, 95% CI 1.00 to 1.08; participants = 2615; studies = 22/comparisons = 26; low quality evidence) by home-based participants. AUTHORS' CONCLUSIONS: This update supports previous conclusions that home- and centre-based forms of cardiac rehabilitation seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction or revascularisation, or with heart failure. This finding supports the continued expansion of evidence-based, home-based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme may reflect local availability and consider the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based cardiac rehabilitation reported in the included short-term trials can be confirmed in the longer term and need to consider adequately powered non-inferiority or equivalence study designs.

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  • There was no difference in secondary prevention of coronary heart disease mortality with a telephone-mediated health behaviour change programme.

    “There was also no difference in secondary prevention of coronary heart disease mortality with a telephone-mediated health behaviour change programme [92], [93].”

    From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [93]

    The Results (Effects of interventions, Mortality; page not provided) found no significant difference in all-cause mortality between home- and centre-based cardiac rehabilitation. The included studies did not report cardiac-specific deaths separately, and the comparison was not specifically a telephone-mediated health behaviour change programme. (LLM, conf=0.88)

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Authors
Taylor, R. S., Dalal, H., Jolly, K., Moxham, T., & Zawada, A.
Affiliations
University of Exeter (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2010-01-19
Volume
6
Issue
1
Pages
CD007130-CD007130
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd007130.pub2
PMC
PMC4160096
OpenAlex
W1822606168
Cited by
623
References
18
Citations by year
2026: 4 · 2025: 12 · 2024: 39 · 2023: 64 · 2022: 59 · 2021: 79 · 2020: 47 · 2019: 54 · 2018: 46 · 2017: 43 · 2016: 48 · 2015: 29 · 2014: 15 · 2013: 23 · 2012: 28
Type
reference entry
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
home-based cardiac rehabilitation, supervised exercise, myocardial infarction, heart failure, revascularization, exercise capacity, mortality, health-related quality of life, cardiovascular risk factors, access to rehabilitation services, risk of bias, risk of bias assessment, risk of bias summary table
MeSH terms
Adult, Aged, Female, Home Care Services, Humans, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Rehabilitation Centers, Randomized Controlled Trials as Topic

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