The quality of evidence is downgraded by inconsistency (heterogeneity of the interventions used) and by indirectness (mostly male samples).
A Cochrane review [Abstract] 1 included 26 studies with a total of 5 299 subjects. Most study participants were middle-aged male patients with acute coronary syndrome (± revascularisation). Ten studies included patients with heart failure. Sixteen studies (n=3 164) were of interventions to improve enrolment in cardiac rehabilitation, 11 studies (n=2 319) of interventions to improve adherence, and 7 studies (n=1 567) of interventions to increase programme completion. A variety of interventions to increase utilisation of cardiac rehabilitation were tested, e.g. contacts made by a healthcare provider during or shortly after an acute care hospitalisation.Interventions were usually multi-faceted, and researchers studied many different combinations of techniques. Very few studies evaluated a single intervention strategy.
Interventions on increasing programme enrolment were effective (RR 1.27, 95% CI 1.13 to 1.42; 16 studies, n=3 096, statistical heterogeneity I2 =61%). Meta-regression revealed that the intervention deliverer (nurse or allied healthcare provider) and the delivery format (face-to-face) were influential. Also, interventions to increase adherence were effective (SMD 0.38, 95% CI 0.20 to 0.55; 9 studies, n=1 654, statistical heterogeneity I2 =53%), particularly when they were delivered remotely, such as in home-based programs (SMD 0.56, 95% CI 0.37 to 0.76). Interventions to increase programme completion were also effective (RR 1.13, 95% CI 1.02 to 1.25; 8 studies, n=1 565), but those applied in multi-centre studies were less effective than those given in single-centre studies (leading to questions regarding generalisability).
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