title: A systematic review of the Heart Manual literature.
abstract: OBJECTIVE
  To compare the efficacy of the Heart Manual, a self help, home based cardiac rehabilitation programme, with hospital based cardiac rehabilitation programmes. Comparisons were made on key psychological, behavioural, biological, service and cost outcomes.
  
  
  METHODS
  A systematic review was conducted. Nine electronic databases and the internet were searched. Non published trials of the Heart Manual were sourced from the Heart Manual department and additional experts in the field were contacted. Randomised controlled trials (RCTs), controlled trials and clinical trials were included if they compared the Heart Manual to another type of cardiac rehabilitation.
  
  
  RESULTS
  Seven studies, including two RCTs, met the inclusion criteria. The RCTs found no significant difference between the Heart Manual and hospital based cardiac rehabilitation. The remaining studies showed mixed results. There was no strong evidence that the Heart Manual was any less effective than hospital based cardiac rehabilitation on any of the outcome measures.
  
  
  CONCLUSIONS
  Evidence from two RCTs suggests the Heart Manual is as effective as hospital based cardiovascular rehabilitation on a number of psychological, behavioural, biological, service and cost outcomes. Future research, such as RCTs carried out on an international scale, should be undertaken to further assess the Heart Manual's efficacy.
authors.affiliation: Heart Manual Department, Astley Ainslie Hospital, NHS Lothian, Edinburgh EH9 2HL, Scotland, UK. michelle.clark@nhslothian.scot.nhs.uk
authors.forename: Michelle
authors.initials: M
authors.lastname: Clark
authors.forename: Tony
authors.initials: T
authors.lastname: Kelly
authors.forename: Carolyn
authors.initials: C
authors.lastname: Deighan
mesh_terms: D000203:Activities of Daily Living; D000553:Ambulatory Care / Q000379:methods; D003324:Coronary Artery Disease / Q000451:nursing* / Q000534:rehabilitation*; D006801:Humans; D019145:Rehabilitation Nursing / Q000379:methods*