ReviewHome-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: A systematic review and meta-analysis
Introduction
Cardiac rehabilitation is a multidisciplinary activity that aims to facilitate physical, psychological and emotional recovery and to enable patients to achieve and maintain better health [1]. This is generally achieved through exercise, relaxation and health education, usually provided to groups of patients within a hospital or community setting. There is good evidence that both exercise-only and comprehensive cardiac rehabilitation programmes are effective, reducing all-cause mortality by 27% following a myocardial infarction [2], [3]. The National Service Framework for Coronary Heart Disease in England and Wales seeks to expand the uptake and coverage of cardiac rehabilitation to patients following a heart attack, coronary artery bypass graft or coronary angioplasty, and also patients with heart failure and angina [4]. However, using current models of cardiac rehabilitation, this would need considerable protracted investment.
Uptake of hospital-based cardiac rehabilitation programmes is poor, particularly among women, the elderly and people from minority ethnic groups [1]. Home-based cardiac rehabilitation programmes were first reported in the early 1980s and might be more acceptable and convenient for some patients, thus increasing uptake. This review explores whether there is any evidence that home-based cardiac rehabilitation programmes are superior to usual care in improving cardiac risk factors and mortality and whether benefits occur to patients' post-myocardial infarction (MI) and after a revascularisation procedure. In addition we have explored whether the outcomes from home-based cardiac rehabilitation are similar to centre (or hospital) -based programmes.
The objective of this systematic review was to critically appraise the available data and determine the effectiveness of home-based cardiac rehabilitation programmes compared with (i) usual care and (ii) supervised centre (or hospital) -based cardiac rehabilitation on mortality, health related quality of life and modifiable cardiac risk factors of patients with coronary heart disease.
Section snippets
Methods
We conducted computer searches with standardised search strategies. We searched Medline (1966 to June 2003), EMBASE (1980 to June 2003), CINAHL (1982 to June 2003), and the Cochrane Controlled Trials Register (issue 3, 2003). The search strategy was used to identify randomised controlled trials (RCTs) of home-based cardiac rehabilitation. In addition we manually searched reference lists of retrieved articles and review articles. Unpublished trials were sought by contacting experts in the field
Results
Fig. 1 shows details of exclusion and inclusion of studies. Table 1, Table 2 show details of the 21 included trials.
Discussion
We believe that this is the first systematic review of home-based cardiac rehabilitation interventions compared to usual care and centre-based supervised rehabilitation. The current standard practice for cardiac rehabilitation is hospital provision in the UK and many other countries, but home-based programmes are an alternative for low to moderate risk patients. Increasingly, risk stratification is carried out at the time of referral to determine short and long term risk with allocation to a
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