Home-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: a systematic review and meta-analysis.
BACKGROUND
To determine the effectiveness of home-based cardiac rehabilitation programmes compared with (i) usual care and (ii) supervised centre-based cardiac rehabilitation on mortality, health related quality of life and modifiable cardiac risk factors of patients with coronary heart disease.


METHODS
Systematic review and meta-analysis of randomised controlled trials.


METHODS
mortality, smoking cessation, exercise capacity, systolic blood pressure, total cholesterol, psychological status, and health related quality of life.


RESULTS
Eighteen included trials for home versus usual rehabilitation and six trials of home versus supervised centre-based rehabilitation were identified. The home-based interventions were clinically heterogeneous, trials often small, with quality poorly reported. Compared with usual care, home-based cardiac rehabilitation had a 4 mm Hg (95% CI 6.5, 1.5) greater reduction in systolic blood pressure, and a reduced relative risk of being a smoker at follow-up (RR 0.71, 95% CI 0.51, 1.00). Differences in exercise capacity, total cholesterol, anxiety and depression were all in favour of the home-based group. In patients post-myocardial infarction exercise capacity was significantly improved in the home rehabilitation group by 1.1 METS (95% CI 0.2, 2.1) compared to usual care. The comparison of home-based with supervised centre-based cardiac rehabilitation revealed no significant differences in exercise capacity, systolic blood pressure and total cholesterol.


CONCLUSIONS
Current evidence does not show home-based cardiac rehabilitation to be significantly inferior to centre-based rehabilitation for low-risk cardiac patients. However, the numbers of patients included are less than 750 and ongoing trials will contribute to the debate on the acceptability, effectiveness and cost-effectiveness of home-based cardiac rehabilitation.
Jolly
Kate
K
Department of Public Health and Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Taylor
Rod S
RS
Lip
Gregory Y H
GY
Stevens
Andrew
A
D016507:Cardiology Service, Hospital; D006331:Heart Diseases / Q000534:rehabilitation*; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D010044:Outpatient Clinics, Hospital; D011787:Quality of Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012046:Rehabilitation / Q000379:methods; D012047:Rehabilitation Centers / Q000592:standards*; D016896:Treatment Outcome