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Evidence summaries

Home-Based Versus Centre-Based Cardiac Rehabilitation

Home- and centre-based cardiac rehabilitation may be similar in their benefits on exercise capacity, health-related quality of life, and mortality in patients after myocardial infarction, or revascularisation, or with heart failure. Level of evidence: "C"

The certainty of the evidence is downgraded by study quality (unclear allocation concealment and blinding) and by inconsistency (unexplained variability in results).

Summary

A Cochrane review [Abstract] 1 included 24 studies with a total of 3 046 subjects undergoing cardiac rehabilitation following an acute myocardial infarction (MI) or revascularisation, or with heart failure. The aim of the review was to compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation. Models of home-based rehabilitation varied widely, but all studies included formal supervision by a qualified healthcare or exercise professional.

No difference was seen between home- and centre-based cardiac rehabilitation in the primary outcomes up to 12 months of follow up: mortality (RR 1.19, 95% CI 0.65 to 2.16; 12 studies, n=1 647), or exercise capacity (SMD -0.10, 95% CI -0.24 to 0.04; statistical heterogeneity I2 =60%; 24 studies, n=2 343). The majority of evidence showed no significant difference in health-related quality of life up to 24 months follow-up. Trials were generally of short duration, with only 3 studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; n=1 074). No differences in trial completion (RR 1.04, 95% CI 0.99 to 1.08; statistical heterogeneity I2 =55%; 22 studies, n=2 638) or cost per patient between home-based and centre-based participants were observed.

    References

    • McDonagh ST, Dalal H, Moore S, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023;10(10):CD007130 [PubMed]

Primary/Secondary Keywords