Home-based versus centre-based cardiac rehabilitation

By R. Taylor, Hayes M Dalal, K. Jolly, T. Moxham, A. Zawada. Cochrane Database of Systematic Reviews, 2010

691 citations recorded by the source corpus.

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 methods 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) was 1.31 (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.

View Paper: https://www.semanticscholar.org/paper/956a2d8bd0d846608aca8dd600f546fea82b7bfb

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

1. T. Ivanova
2. G. Fletcher
3. I. Graham
4. J. Nolan
5. M. Piepoli
6. J. Perk
7. C. Sandroni
8. P. Ades

Citations in the corpus

• 2016 European Guidelines on cardiovascular disease prevention in clinical practice (2017, unknown): “centre-based rehabilitation found no difference in outcomes, adherence or cost between the two in the short term and up to 24 months [566].”
• Exercise standards for testing and training: a scientific statement from the American Heart Association. (2013, background): “Home-Monitored Cardiac Rehabilitation In a systematic review of data from 12 randomized controlled trials (1938 participants) conducted in 6 different countries, the effectiveness of home-based cardiac rehabilitation was compared with supervised traditional cardiac rehabilitation; no difference in o”
• Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. (2020, background): “In selected sub-groups, centre-based cardiac rehabilitation may be substituted for home-based rehabilitation, which is non-inferior.(38) The components and type of programme offered differ widely by country, affected mainly by disparities on standards, legislation and reimbursement.”
• 2016 European Guidelines on cardiovascular disease prevention in clinical practice. (2016, background): “centre-based rehabilitation found no difference in outcomes, adherence or cost between the two in the short term and up to 24 months.(566) The majority of studies recruited low-risk, predominantly male patients, and activities were self-regulated with intermittent support, usually by”
• European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. (2021, background): “Cardiac rehabilitation is frequently offered as a centre-based out-patient service, but can also be organised in a home-based setting in combination with telemonitoring [508].”
• 2016 European Guidelines on cardiovascular disease prevention in clinical practice (2016, background): “centre-based rehabilitation found no difference in outcomes, adherence or cost between the two in the short term and up to 24 months.(566) The majority of studies recruited low-risk, predominantly male patients, and activities were self-regulated with intermittent support, usually by”
• Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association (2016, background): “although tailored approaches increase the likelihood of success.(322,323) Even with a CR referral, women participate in CR”
• European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care (2021, background): “Cardiac rehabilitation is frequently offered as a centre-based out-patient service, but can also be organised in a home-based setting in combination with telemonitoring [508].”