Alternative models of cardiac rehabilitation: a systematic review.
The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.
School of Nursing and Midwifery, Flinders University, Adelaide, Australia robyn.clark@flinders.edu.au.
Robyn A
RA
Clark
School of Nursing and Institute of Health and Biomedical Innovation, Queensland University Technology, Australia.
Aaron
A
Conway
National Heart Foundation of Australia, Australia.
Vanessa
V
Poulsen
National Heart Foundation of Australia, Australia.
Wendy
W
Keech
Integrated Cardiovascular Clinical Network, South Australia.
Rosy
R
Tirimacco
Integrated Cardiovascular Clinical Network, South Australia.
Phillip
P
Tideman
D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D003131:Combined Modality Therapy; D000529:Complementary Therapies / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005081:Exercise Therapy / Q000458:organization & administration; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006801:Humans; D009937:Organizational Objectives; D010348:Patient Care Team / Q000458:organization & administration; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017216:Telemedicine / Q000458:organization & administration*; D016896:Treatment Outcome
Acute coronary syndrome; cardiac rehabilitation; cardiovascular diseases; coronary disease; internet; myocardial infarction; risk factors; systematic review; telemedicine