Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
16 January 2024Cardiovascular disease is the most common cause of death worldwide. Cardiac rehabilitation aims to restore people with heart disease to health, through exercise, education and psychological support. Traditionally, centre-based cardiac rehabilitation programmes (typically based at hospital clinics, gyms or community centres) are offered to patients after cardiac events (such as heart attacks) or surgery to support recovery and prevent further illness. However, uptake of such programmes has been, and remains, suboptimal, in many countries across the world, due to barriers such as travel, cost and dislike of group interventions, particularly in ethnic minorities, women, older individuals and those living with complex health conditions or in rural or high deprivation areas.
Home-based programmes are increasingly being offered as an alternative to centre-based programmes, with the aim of increasing access to, and participation in, cardiac rehabilitation. In 2017, our research team undertook a Cochrane review and found home- and centre-based cardiac rehabilitation to be equally effective in improving both clinical and health-related quality of life outcomes in patients with heart disease.
Since the COVID-19 pandemic, there have been numerous calls for, and emphasis on, healthcare providers offering more remote, home-based and technology supported modes of delivery for cardiac rehabilitation, which has resulted in an increased number of publications in this area. Therefore, the aim of this study was to update the previous Cochrane review and compare the effects of centre- and home-based (with or without digital/telehealth platforms) cardiac rehabilitation programmes on health-related outcomes in patients with heart disease.
We undertook a comprehensive literature search on 16th September 2022 to identify relevant randomised controlled trials published since the previous review. After deduplication, 13,891 title and abstracts and 319 full texts were screened. Three new relevant trials were identified and included in this update; 24 trials and 3046 participants were included in analysis overall (after combining with previous review data).
We found no difference in cost-effectiveness or outcomes (such as mortality, cardiac events, exercise capacity, health-related quality of life, trial completion or modifiable risk factors) for short (3-12 months) or longer term (>12 months) follow-up between home- (including digital/telehealth platforms) and centre-based cardiac rehabilitation programmes for individuals with heart disease.
These findings, together with some evidence to support higher levels of adherence with home-based modes of delivery, support the notion that healthcare providers should offer alternative modes of cardiac rehabilitation more widely. Barriers to participation in rehabilitation must be considered; upskilling healthcare professionals and patients in the use of digital and telehealth methods is key to the success of implementing new forms of remote and hybrid rehabilitation. Future work may consider other clinical populations and better reporting of costs, intervention fidelity and validated patient outcomes.
The full review has been published in the Cochrane Database of Systematic Reviews https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007130.pub5/full. We have also published a brief summary of the findings as a Cochrane Corner in Heart https://heart.bmj.com/content/110/1/7.