Traditional centre-based cardiac rehabilitation (CR) programmes have been developed and evaluated in various countries for more than four decades.1 The evidence for the effectiveness of CR in coronary heart disease has been accumulating and the benefits in terms of reductions in cardiovascular mortality and unplanned hospital readmissions coupled with an improvement in health-related quality of life.2 Comprehensive CR is now recommended by several international guidelines and all eligible patients with coronary heart disease including heart failure are encouraged to participate in CR.3 ,4 However, the uptake and usage of CR has remained suboptimal—with participation rates of 10%–30% reported in Europe, USA and Australia.5 Reasons given for poor uptake include low referral rates, problems with transport especially in rural locations, work commitments, a dislike of groups and a lack of funding and trained healthcare personnel.3 ,5 To remedy this, there have been calls to make CR interventions more patient centred with policies that support initiatives offering alternatives to centre-based CR.6 Emerging models of alternative CR which may increase participation include home-based and telehealth-based CR delivered to individuals.3 ,5

In their Heart publication, Rawstorn et al report on a systematic review and meta-analysis seeking to determine the benefits of telehealth exercise-based CR compared with traditional centre-based CR or usual care on exercise …