Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis

S A Buckingham, R S Taylor, K Jolly, A Zawada, S G Dean, A Cowie, R J Norton, H M Dalal, S A Buckingham, R S Taylor, K Jolly, A Zawada, S G Dean, A Cowie, R J Norton, H M Dalal

Abstract

Objective: To update the Cochrane review comparing the effects of home-based and supervised centre-based cardiac rehabilitation (CR) on mortality and morbidity, quality of life, and modifiable cardiac risk factors in patients with heart disease.

Methods: Systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL were searched up to October 2014, without language restriction. Randomised trials comparing home-based and centre-based CR programmes in adults with myocardial infarction, angina, heart failure or who had undergone coronary revascularisation were included.

Results: 17 studies with 2172 patients were included. No difference was seen between home-based and centre-based CR in terms of: mortality (relative risk (RR) 0.79, 95% CI 0.43 to 1.47); cardiac events; exercise capacity (mean difference (MD) -0.10, -0.29 to 0.08); total cholesterol (MD 0.07 mmol/L, -0.24 to 0.11); low-density lipoprotein cholesterol (MD -0.06 mmol/L, -0.27 to 0.15); triglycerides (MD -0.16 mmol/L, -0.38 to 0.07); systolic blood pressure (MD 0.2 mm Hg, -3.4 to 3.8); smoking (RR 0.98, 0.79 to 1.21); health-related quality of life and healthcare costs. Lower high-density lipoprotein cholesterol (MD -0.07 mmol/L, -0.11 to -0.03, p=0.001) and lower diastolic blood pressure (MD -1.9 mm Hg, -0.8 to -3.0, p=0.009) were observed in centre-based participants. Home-based CR was associated with slightly higher adherence (RR 1.04, 95% CI 1.01 to 1.07).

Conclusions: Home-based and centre-based CR provide similar benefits in terms of clinical and health-related quality of life outcomes at equivalent cost for those with heart failure and following myocardial infarction and revascularisation.

Keywords: CORONARY ARTERY DISEASE; HEART FAILURE.

Figures

Figure 1
Figure 1
Summary of study selection process.RCT, randomised controlled trial.
Figure 2
Figure 2
Summary of risk of bias assessment (authors’ judgements about each methodological quality item for each included study).
Figure 3
Figure 3
(A) Exercise capacity with home-based and centre-based CR at ≤12 months’ follow-up. (B) Exercise capacity with home-based and centre-based CR at 12–24 months’ follow-up. CR, cardiac rehabilitation.

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