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Cited by 487Cardiac Health and Mental HealthCardiovascular and exercise physiologyMedical Practices and Rehabilitation

Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis

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Dalal, H. M, Zawada, A., Jolly, K., Moxham, T., Taylor, R. S·2010·BMJ
DOI 10.1136/bmj.b5631PMC PMC2808470
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Abstract

OBJECTIVE: To compare the effect of home based and supervised centre based cardiac rehabilitation on mortality and morbidity, health related quality of life, and modifiable cardiac risk factors in patients with coronary heart disease. DESIGN: Systematic review. DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, Embase, CINAHL, and PsycINFO, without language restriction, searched from 2001 to January 2008. REVIEW METHODS: Reference lists checked and advice sought from authors. Included randomised controlled trials that compared centre based cardiac rehabilitation with home based programmes in adults with acute myocardial infarction, angina, or heart failure or who had undergone coronary revascularisation. Two reviewers independently assessed the eligibility of the identified trials and extracted data independently. Authors were contacted when possible to obtain missing information. RESULTS: 12 studies (1938 participants) were included. Most studies recruited patients with a low risk of further events after myocardial infarction or revascularisation. No difference was seen between home based and centre based cardiac rehabilitation in terms of mortality (relative risk 1.31, 95% confidence interval 0.65 to 2.66), cardiac events, exercise capacity (standardised mean difference -0.11, -0.35 to 0.13), modifiable risk factors (weighted mean difference systolic blood pressure (0.58 mm Hg, -3.29 mm Hg to 4.44 mm Hg), total cholesterol (-0.13 mmol/l, -0.31 mmol/l to 0.05 mmol/l), low density lipoprotein cholesterol (-0.15 mmol/l, -0.31 mmol/l to 0.01 mmol/l), or relative risk for proportion of smokers at follow-up (0.98, 0.73 to 1.31)), or health related quality of life, with the exception of high density lipoprotein cholesterol (-0.06, -0.11 to -0.02) mmol/l). In the home based participants, there was evidence of superior adherence. No consistent difference was seen in the healthcare costs of the two forms of cardiac rehabilitation. CONCLUSIONS: Home and centre based forms of cardiac rehabilitation seem to be equally effective in improving clinical and health related quality of life outcomes in patients with a low risk of further events after myocardial infarction or revascularisation. This finding, together with the absence of evidence of differences in patients' adherence and healthcare costs between the two approaches, supports the further provision of evidence based, home based cardiac rehabilitation programmes such as the "Heart Manual." The choice of participating in a more traditional supervised centre based or evidence based home based programme should reflect the preference of the individual patient.

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  • Dalal et al found no significant difference in cardiovascular events (stroke, transient ischaemic attacks and heart failure) between home-based and centre-based cardiac rehabilitation.

    “and no significant difference in cardiovascular events (stroke, transient ischaemic attacks and heart failure).”

    From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [70]

    The Results > Clinical events section (page not provided) reports no significant difference in cardiac events between home-based and centre-based rehabilitation. But the events it names are bypass grafting, angioplasty, myocardial infarction and revascularisation—not stroke, transient ischaemic attacks or heart failure. The claim’s specific list of events is therefore unsupported by this source. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Dalal et al found no difference in mortality between home-based and centre-based cardiac rehabilitation (relative risk 1.3, 95% CI 0.7 to 2.7).

    “Dalal et al found no difference in mortality (relative risk 1.3 95% C.I. 0.7 to 2.7) [70]”

    From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [70]

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Research works printed but not linked: 36

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Authors
Dalal, H. M., Zawada, A., Jolly, K., Moxham, T., & Taylor, R. S.
Affiliations
University of Birmingham (GB)
Corresponding author
Dalal, H. M
ORCID
Venue
BMJ
Publisher
BMJ
Published
2010-01-19
Volume
340
Issue
jan19 4
Pages
b5631-b5631
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.b5631
PMC
PMC2808470
OpenAlex
W1969930854
Cited by
487
References
6
Citations by year
2026: 7 · 2025: 13 · 2024: 18 · 2023: 20 · 2022: 27 · 2021: 38 · 2020: 29 · 2019: 32 · 2018: 37 · 2017: 34 · 2016: 39 · 2015: 34 · 2014: 30 · 2013: 39 · 2012: 33
FWCI
6.89
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • Figshare (submittedVersion)
  • Open Research Exeter (University of Exeter) (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, coronary artery disease, myocardial infarction, coronary revascularization, heart failure, angina pectoris, mortality, morbidity, health-related quality of life, exercise capacity, modifiable risk factors, smoking, adherence, health care costs, supervised exercise programme, cardiovascular risk factors, LDL cholesterol, HDL cholesterol, systolic blood pressure
MeSH terms
Adult, Coronary Disease, Exercise Therapy, Home Care Services, Humans, Quality of Life, Rehabilitation Centers, Bias, Randomized Controlled Trials as Topic, Treatment Outcome, Directly Observed Therapy

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