title: Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) is an evidence-based recommendation for patients with coronary artery disease (CAD). However, CR is dramatically underutilized. Telehealth interventions have the potential to overcome barriers and may be an innovative model of delivering CR. This review aimed to determine the effectiveness of telehealth intervention delivered CR compared with center-based supervised CR.
  
  
  METHODS
  Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library and the Chinese BioMedical Literature Database (CBM), were searched to April 2014, without language restriction. Existing randomized controlled trials, reviews, relevant conference lists and gray literature were checked. Randomized controlled trials that compared telehealth intervention delivered CR with traditional center-based supervised CR in adults with CAD were included. Two reviewers selected studies and extracted data independently. Main clinical outcomes including clinical events, modifiable risk factors or other endpoints were measured.
  
  
  RESULTS
  Fifteen articles reporting nine trials were reviewed, most of which recruited patients with myocardial infarction or revascularization. No statistically significant difference was found between telehealth interventions delivered and center-based supervised CR in exercise capacity (standardized mean difference (SMD) -0.01; 95% confidence interval (CI) -0.12-0.10), weight (SMD -0.13; 95% CI -0.30-0.05), systolic and diastolic blood pressure (mean difference (MD) -1.27; 95% CI -3.67-1.13 and MD 1.00; 95% CI -0.42-2.43, respectively), lipid profile, smoking (risk ratio (RR) 1.03; 95% CI 0.78-1.38), mortality (RR 1.15; 95% CI 0.61-2.19), quality of life and psychosocial state.
  
  
  CONCLUSIONS
  Telehealth intervention delivered cardiac rehabilitation does not have significantly inferior outcomes compared to center-based supervised program in low to moderate risk CAD patients. Telehealth intervention offers an alternative deliver model of CR for individuals less able to access center-based cardiac rehabilitation. Choices should reflect preferences, anticipation, risk profile, funding, and accessibility to health service.
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Kaisen
authors.initials: K
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Emergency Department, People's Hospital of Deyang City, PR China.
authors.forename: Dingxiu
authors.initials: D
authors.lastname: He
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Baotao
authors.initials: B
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Dan
authors.initials: D
authors.lastname: Xiao
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Yong
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Hongde
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Cardiology, West China Hospital, PR China.
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Cardiology, West China Hospital, PR China huangdjmd@163.com.
authors.forename: Dejia
authors.initials: D
authors.lastname: Huang
mesh_terms: D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D003695:Delivery of Health Care / Q000379:methods*; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D008019:Life Style; D008055:Lipids / Q000097:blood; D008603:Mental Health; D016017:Odds Ratio; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods*; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008055:Lipids
keywords: Coronary artery disease; cardiac rehabilitation; secondary prevention; telehealth