Home-Based Cardiac Rehabilitation Alone and Hybrid With Center-Based Cardiac Rehabilitation in Heart Failure: A Systematic Review and Meta-Analysis

Abstract

Background Center-based cardiac rehabilitation (CBCR) has been shown to improve outcomes in patients with heart failure (HF). Home-based cardiac rehabilitation (HBCR) can be an alternative to increase access for patients who cannot participate in CBCR. Hybrid cardiac rehabilitation (CR) combines short-term CBCR with HBCR, potentially allowing both flexibility and rigor. However, recent data comparing these initiatives have not been synthesized. Methods and Results We performed a meta-analysis to compare functional capacity and health-related quality of life (hr-QOL) outcomes in HF for (1) HBCR and usual care, (2) hybrid CR and usual care, and (3) HBCR and CBCR. A systematic search in 5 standard databases for randomized controlled trials was performed through January 31, 2019. Summary estimates were pooled using fixed- or random-effects (when I²>50%) meta-analyses. Standardized mean differences (95% CI) were used for distinct hr-QOL tools. We identified 31 randomized controlled trials with a total of 1791 HF participants. Among 18 studies that compared HBCR and usual care, participants in HBCR had improvement of peak oxygen uptake (2.39 mL/kg per minute; 95% CI, 0.28-4.49) and hr-QOL (16 studies; standardized mean difference: 0.38; 95% CI, 0.19-0.57). Nine RCTs that compared hybrid CR with usual care showed that hybrid CR had greater improvements in peak oxygen uptake (9.72 mL/kg per minute; 95% CI, 5.12-14.33) but not in hr-QOL (2 studies; standardized mean difference: 0.67; 95% CI, -0.20 to 1.54). Five studies comparing HBCR with CBCR showed similar improvements in functional capacity (0.0 mL/kg per minute; 95% CI, -1.93 to 1.92) and hr-QOL (4 studies; standardized mean difference: 0.11; 95% CI, -0.12 to 0.34). Conclusions HBCR and hybrid CR significantly improved functional capacity, but only HBCR improved hr-QOL over usual care. However, both are potential alternatives for patients who are not suitable for CBCR.

Keywords: cardiac rehabilitation; exercise; heart failure; meta‐analysis.

Figure 1

Comparison of functional capacity between home‐based cardiac rehabilitation and usual care. CBCR indicates center‐based cardiac rehabilitation; RCTs, randomized controlled trials.

Figure 2

Functional capacity significantly improved in home‐based cardiac rehabilitation (HBCR) compared with usual care; 1 standardized mean difference (SMD)=7.02 mL/kg per minute.

Figure 3

Comparison of functional capacity between hybrid cardiac rehabilitation (CR) and usual care. Functional capacity significantly improved in hybrid CR compared with usual care; 1 standardized mean difference (SMD)=5.23 mL/kg per minute.

Figure 4

Comparison of health‐related quality of life between home‐based cardiac rehabilitation (HBCR) and usual care. Health‐relate quality of life significantly improved with HBCR compared with usual care. CHF Questionnaire indicates Chronic Heart Failure Questionnaire; KCCQ, Kansas City Cardiomyopathy Questionnaire; MLWHF, Minnesota Living with Heart Failure; SF‐36, Short Form 36; SMD, standardized mean difference.