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Meta-Analysis
. 2010 Jan 20:(1):CD007130.
doi: 10.1002/14651858.CD007130.pub2.

Home-based versus centre-based cardiac rehabilitation

Rod S Taylor  1 , Hayes Dalal, Kate Jolly, Tiffany Moxham, Anna Zawada
Affiliations
Meta-Analysis

Home-based versus centre-based cardiac rehabilitation

Rod S Taylor et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Traditionally centre-based cardiac rehabilitation (CR) 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.

Objectives: To determine the effectiveness of home-based cardiac rehabilitation programmes compared with 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.

Search strategy: We updated the search of a previous review by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2007, Issue 4), MEDLINE, EMBASE and CINAHL from 2001 to January 2008. We checked reference lists and sought advice from experts. No language restrictions were applied.

Selection criteria: Randomised controlled trials (RCTs) 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: Studies were selected independently by two reviewers, and data extracted by a single reviewer and checked by a second one. Authors were contacted where possible to obtain missing information.

Main results: Twelve studies (1,938 participants) met the inclusion criteria. The majority of studies recruited a lower risk patient following an acute myocardial infarction (MI) and revascularisation. There was no difference in outcomes of home- versus centre-based cardiac rehabilitation in mortality risk ratio (RR) was1.31 (95% confidence interval (C) 0.65 to 2.66), cardiac events, exercise capacity standardised mean difference (SMD) -0.11 (95% CI -0.35 to 0.13), as well as in modifiable risk factors (systolic blood pressure; diastolic blood pressure; total cholesterol; HDL-cholesterol; LDL-cholesterol) or proportion of smokers at follow up or health-related quality of life. There was no consistent difference in the healthcare costs of the two forms of cardiac rehabilitation.

Authors' conclusions: Home- and centre-based cardiac rehabilitation appear to be equally effective in improving the clinical and health-related quality of life outcomes in acute MI and revascularisation patients. This finding, together with an absence of evidence of difference in healthcare costs between the two approaches, would support the extension of home-based cardiac rehabilitation programmes such as the Heart Manual to give patients a choice in line with their preferences, which may have an impact on uptake of cardiac rehabilitation in the individual case.

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Figures

Figure 1
Figure 1. Summary of study selection process
* Two of the studies had three comparison arms and these have been analysed separately giving in total 14 comparisons.
Figure 2
Figure 2. Methodological quality summary: review authors’ judgements about each methodological quality item for each included study
Figure 3
Figure 3. Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies
See this image and copyright information in PMC

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References

References to studies included in this review

    1. *

    2. Arthur HM, Smith KM, Kodis J, McKelvie R. A controlled trial of hospital versus home-based exercise in cardiac patients. Medicine and Science in Sports and Exercise. 2002;34(10):1544–50. - PubMed
    1. Smith KM, Arthur HM, McKelvie RS, Kodis J. Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation. European Journal of Cardiovascular Prevention and Rehabilitation. 2004;11(4):313–9. - PubMed
    1. Bell JM. Thesis submitted to the University of London for the degree of Doctor of Philosophy. 1998. A comparison of a multi-disciplinary home based cardiac rehabilitation programme with comprehensive conventional rehabilitation in post-myocardial infarction patients.
    1. Carlson J. A comparison of traditional and modified cardiac rehabilitation protocols on compliance to exercise, patient self-efficacy, cardiovascular outcomes, and program cost. Dissertation Abstracts International: Section B: The Sciences and Engineering. 1999;59(7-B):3388.

    1. *

    2. Carlson JJ, Johnson JA, Franklin BA, VanderLaan RL. Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. American Journal of Cardiology. 2000;86(1):17–23. - PubMed

References to studies excluded from this review

    1. Ades PA, Pashkow FJ, Fletcher G, Pina IL, Zohman LR, Nestor JR. A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring. American Heart Journal. 2000;139(3):543–8. - PubMed
    1. Senuzun F, Fadiloglu C, Burke L, Payzin S. Effects of home-based cardiac exercise program on the exercise tolerance, serum lipid values and self-efficacy of coronary patients. European Journal of Cardiovascular Prevention and Rehabilitation. 2006;13(4):640–5. - PubMed
    1. Sinclair A, Conroy S, Davies M, Bayer A. Post-discharge home-based support for older cardiac patients: a randomised controlled trial. Age and Ageing. 2005;34(4):338–43. - PubMed
    1. Tygesen H, Wettervik C, Wennerblom B. Intensive home-based exercise training in cardiac rehabilitation increases exercise capacity and heart rate variability. International Journal of Cardiology. 2001;79(2-3):175–82. - PubMed

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    1. Allender S, Peto V, Scarborough P, Kaur A, Rayner M. Coronary heart disease statistics. British Heart Foundation; London: 2008.
    1. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007;115(20):2675–82. - PubMed
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    1. Beswick AD, Rees K, Griebsch I, Taylor FC, Burke M, West RR, et al. Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups. Health Technology Assessment. 2004;8(41):1–166. - PubMed
    1. Davies P, Beswick A, Wise F, Harris, Moxham T, Taylor F, Taylor RS. Promoting patient uptake and adherence in cardiac rehabilitation (Protocol) Cochrane Database of Systematic Reviews. 2008;(2) DOI: 10.1002/14651858.CD007131. - PMC - PubMed

References to other published versions of this review

    1. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ. 2010;340:b5631. - PMC - PubMed

    1. * Indicates the major publication for the study