title: Home-based cardiac rehabilitation for people with heart failure: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs.
  
  
  METHODS
  Randomised controlled trials were initially identified from previous systematic reviews of CR. We undertook updated literature searches of MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Library to December 2015. A total of 19 trials with median follow up of 3months were included - 17 comparisons of home-based CR to usual care (995 patients) and four comparing home and centre-based CR (295 patients).
  
  
  RESULTS
  Compared to usual care, home-based CR improved VO2max (mean difference: 1.6ml/kg/min, 0.8 to 2.4) and total Minnesota Living with Quality of Life score (-3.3, -7.5 to 1.0), with no difference in mortality, hospitalisation or study drop out. Outcomes and costs were similar between home-based and centre-based CR with the exception of higher levels of trial completion in the home-based group (relative risk: 1.2, 1.0 to 1.3).
  
  
  CONCLUSIONS
  Home-based CR results in short-term improvements in exercise capacity and health-related quality of life of heart failure patients compared to usual care. The magnitude of outcome improvement is similar to centre-based CR. Home-based CR appears to be safe with no evidence of increased risk of hospitalisation or death. These findings support the provision of home-based CR for heart failure as an evidence-based alternative to the traditional centre-based model of provision.
authors.affiliation: Danish Centre of Rehabilitation and Palliative Care, University Hospital Odense, Odense, Denmark; University of Southern Denmark, Odense, Denmark.
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.affiliation: Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, UK.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Norton
authors.affiliation: Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Dean
authors.affiliation: Research, Development and Innovation, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK; Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
authors.forename: Hayes
authors.initials: H
authors.lastname: Dalal
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Tang
authors.affiliation: Research, Development and Innovation, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK; Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Wingham
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, UK. Electronic address: r.taylor@exeter.ac.uk.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
mesh_terms: D000072038:Cardiac Rehabilitation / Q000379:methods*; D017079:Exercise Tolerance; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D006699:Home Care Services; D006801:Humans; D010349:Patient Compliance; D010352:Patient Dropouts; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: Cardiac rehabilitation; Exercise training; Heart failure; Meta-analysis; Systematic review