A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease.
BACKGROUND
A variety of different types of secondary prevention programs for coronary heart disease (CHD) exist. Home-based programs have become more common and may be more accessible or preferable to some patients. This review compared the benefits and costs of home-based programs with usual care and cardiac rehabilitation.


METHODS
A meta-analysis following a systematic search of 19 databases, existing reviews, and references was designed. Studies evaluated home-based interventions that addressed more than one main CHD risk factor using a randomized trial with a usual care or cardiac rehabilitation comparison group with data extractable for CHD patients only and reported in English as a full article or thesis.


RESULTS
Thirty-nine articles reporting 36 trials were reviewed. Compared with usual care, home-based interventions significantly improved quality of life [weighted mean difference: 0.23; 95% confidence interval (95% CI): 0.02-0.45], systolic blood pressure (weighted mean difference: -4.36 mmHg; 95% CI: -6.50 to -2.22), smoking cessation (difference in proportion: 14%; 95% CI: 0.02-0.26), total cholesterol (standardized mean difference: -0.33; 95% CI: -0.57 to -0.08), and depression (standardized mean difference: -0.33; 95% CI: -0.59 to -0.07). Effect sizes were small to moderate and trials were of low-to-moderate quality. Comparisons with cardiac rehabilitation could not be made because of the small number of trials and high levels of heterogeneity.


CONCLUSIONS
Home-based secondary prevention programs for CHD are an effective and relatively low-cost complement to hospital-based cardiac rehabilitation and should be considered for stable patients less likely to access or adhere to hospital-based services.
Clark
Alexander M
AM
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. alex.clark@ualberta.ca
Haykowsky
Mark
M
Kryworuchko
Jennifer
J
MacClure
Todd
T
Scott
Jess
J
DesMeules
Marie
M
Luo
Wei
W
Liang
Y
Y
McAlister
Finlay A
FA
D000368:Aged; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000191:economics / Q000401:mortality / Q000517:prevention & control / Q000534:rehabilitation / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000191:economics; D016540:Smoking Cessation; D016896:Treatment Outcome
D002784:Cholesterol