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Review
. 2025 Mar 31:22:100982.
doi: 10.1016/j.ajpc.2025.100982. eCollection 2025 Jun.

Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care: 3-4 months (end of the program) and 9-10 months (6 months after the end of the program)

Eva Marti  1   2 , Anggoro Budi Hartopo  3 , Haryani  4 , Margareta Hesti Rahayu  1   2 , Riris Diana  2   5 , Ninik Yunitri  6
Affiliations
Review

Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care: 3-4 months (end of the program) and 9-10 months (6 months after the end of the program)

Eva Marti et al. Am J Prev Cardiol. .

Abstract

Aim: To assess the effectiveness of home-based cardiac rehabilitation (HBCR) in improving health-related quality of life (HRQoL) and other outcomes in patients with acute coronary syndrome (ACS), compared to hospital-based cardiac rehabilitation (CR) and usual care.

Methods: This systematic review followed PRISMA guidelines and included a comprehensive search across MEDLINE, CINAHL, ProQuest, Cochrane Library, Clinical Key, PubMed, Embase, and ClinicalTrials.gov up to June 2023. A total of 19 studies with 2822 participants were included. Eligible RCTs assessed the impact of HBCR on ACS patients, comparing it with hospital-based CR or usual care. The primary outcome was QoL, with secondary outcomes including cardiovascular capacity, cardiovascular disease risk factors, and rehospitalization rates. Statistical analysis was conducted using a random-effects model in R Statistic.

Results: HBCR improves QoL compared to all comparators (hospital-based CR and usual care) (SMD 0.17, 95 % CI 0.00 to 0.33). HBCR was equally effective as hospital-based CR in enhancing QoL, peak VO2, 6-min walk distance (6 MWD), lipid profiles, and blood pressure. Compared to usual care, HBCR significantly improved QoL (SMD 0.29, 95 % CI 0.11 to 0.46) and HDL-cholesterol level (SMD 0.18, 95 % CI 0.02 to 0.34), while reducing triglyceride level more effectively (SMD -0.34, 95 % CI -0.57 to -0.11). However, no significant differences were observed between HBCR and usual care in terms of peak VO2, rehospitalization rates, LDL-cholesterol, total cholesterol, or blood pressure.

Conclusions: HBCR significantly improves QoL and is equally effective as hospital-based CR across all measured outcomes. Compared to usual care, HBCR leads to significant improvements in specific aspects of QoL as a primary outcome, as well as in HDL-cholesterol and triglyceride levels. However, its impact on other outcomes, such as peak VO2, LDL-cholesterol, total cholesterol, and blood pressure, is not consistently significant.

Keywords: Acute coronary syndromes; Cardiovascular capacity; Home-based cardiac rehabilitation; Meta-analysis; Quality of life; Rehospitalization; Risk factors.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only.
Fig. 2
Fig. 2
Risk of bias in included studies.
Fig. 3
Fig. 3
Effect of HBCR on QoL. A. Effect of HBCR on QoL compared to all comparator; B. Effect of HBCR on QoL compared to Hospital-based CR; C. Effect of HBCR on QoL compared to usual care. HBCR: Home-based Cardiac Rehabilitation, CR: Cardiac Rehabilitation, QoL: Quality of life, SD: Standard Deviation, CI: Confidence Interval, SMD: Standardised Mean Difference.
Fig. 4
Fig. 4
Effect of HBCR on cardiovascular capacity compared to Hospital-based CR. A. Effect of HBCR on 6 MWD compared to Hospital-based CR; B. Effect of HBCR on peak VO2 compared to Hospital-based CR. HBCR: Home-based Cardiac Rehabilitation, CR: Cardiac Rehabilitation, 6 MWD: 6-min walk distance, SD: Standard Deviation, CI: Confidence Interval, SMD: Standardised Mean Difference.
Fig. 5
Fig. 5
Effect of HBCR on lipid profile compared Hospital-based CR. A. Effect HBCR on total cholesterol compared to Hospital-based CR; B. Effect of HBCR on LDL -cholesterol compared to Hospital-based CR; C. Effect HBCR on HDL cholesterol compared to Hospital-based CR. HBCR: Home-based Cardiac Rehabilitation, CR: Cardiac Rehabilitation, HDL: High Density Lipoprotein, LDL: Low Density Lipoprotein, SD: Standard Deviation, CI: Confidence Interval; SMD: Standardised Mean Difference.
Fig. 6
Fig. 6
Effect of HBCR on blood pressure compared to Hospital-based CR. A. Effect of HBCR on systolic blood pressure compared to Hospital-based CR. B. Effect HBCR on diastolic blood pressure compared to Hospital-based CR. HBCR: Home-based Cardiac Cehabilitation, CR: Cardiac rehabilitation, SD: Standard Deviation, CI: Confidence Interval, SMD: Standardised Mean Difference.
Fig. 7
Fig. 7
Effect of HBCR on mortality and rehospitalization compared to usual care. A. Effect of HBCR on mortality compared to usual care. B. Effect of HBCR on rehospitalization compared to usual care. HBCR: Home-based Cardiac Rehabilitation, OR: Odds ratio; CI: Confidence interval.
Fig. 8
Fig. 8
Effect of HBCR on lipid profile compared to usual care. A. Effect of HBCR on total cholesterol compared to usual care; B. Effect of HBCR on LDL cholesterol compared to usual care; C. Effect of HBCR on HDL cholesterol compared to usual care; D. Effect of HBCR on triglycerides compared to usual care. HBCR: Home-based Cardiac Rehabilitation, HDL: High Density Lipoprotein, LDL: Low Density Lipoprotein, SD: Standard Deviation, CI: Confidence Interval, SMD: Standardised Mean Difference.
Fig. 9
Fig. 9
Effect of HBCR on blood pressure compared to usual care. A. Effect of HBCR on systolic blood pressure compared to usual care; B. Effect of HBCR on diastolic blood pressure compared to usual care. HBCR: Home- based Cardiac Rehabilitation, SD: Standard Deviation, CI: Confidence Interval; SMD: Standardised Mean Difference.
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