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Editorial
Time to scale up access to cost-effective home-based/digitally supported models of rehabilitation delivery
  1. Rod Taylor1,
  2. Heather Lynne Fraser2
  1. 1 MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, School of Health and Well Being, University of Glasgow, Glasgow, Scotland, UK
  2. 2 Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to Professor Rod Taylor, University of Glasgow, Glasgow G12 8QQ, UK; rod.taylor{at}gla.ac.uk

https://doi.org/10.1136/heartjnl-2023-322454

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    There is compelling evidence that participation in exercise-based rehabilitation (ExCR) improves health-related of quality of life and reduces the risk of clinical events, including hospitalisation, of people with coronary heart disease (CHD)—post-myocardial infarction, revascularisation and angina—and heart failure (HF). ExCR is a class I grade A recommendation of national and international clinical guidelines for CHD and HF management.1 Nevertheless, despite these clear benefits and strong guidance, ExCR referral and participation rates remain stubbornly low across the globe.2 Whether in a low-income, middle-income or high-income setting, the reasons for this poor access are complex and multilevel. However, two key drivers of future global ExCR access are economics, that is, the provision of affordable and cost-effective ExCR programmes and ‘modernisation’ of ExCR service delivery, that is, the provision of alternatives to the traditional centre-based model of ExCR provision, which includes home-based, digital technology-supported and hybrid (combing centre and remote) programmes.3

    This comprehensive and high-quality systematic review of the cost-effectiveness of home-based cardiac rehabilitation by Shields and colleagues provide a timely summary of the evidence addressing these two key drivers of future ExCR access.4 The review authors identified nine studies that address the cost and health outcomes of home-based/digitally supported modes of rehabilitation: two studies on HF, five studies on CHD and two studies on both. Heterogeneity in study contexts, research questions and the methods used to answer these questions means that synthesis of cost-effectiveness evidence is challenging. This review is no exception; while all included studies were based on randomised trials allocating patients to …

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    Footnotes

    • Collaborators RT is co-chief investigator of the ongoing National Institute for Health and Care Research-funded REACH-HFpEF trial and director of Cardiac Rehabilitation Cochrane Review Centre.

    • Contributors RT and HLF jointly wrote the manuscript and took joint responsibility for its final content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RT is chief investigator of cardiac rehabilitation trials past and present and was director of the Cochrane Heart Rehabilitation Group.

    • Provenance and peer review Commissioned; internally peer reviewed.

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