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Int J Cardiol. 2016 Oct 15;221:963-9. doi: 10.1016/j.ijcard.2016.06.207. Epub 2016 Jun 28.

Home-based cardiac rehabilitation for people with heart failure: A systematic review and meta-analysis.

Author information

1
Danish Centre of Rehabilitation and Palliative Care, University Hospital Odense, Odense, Denmark; University of Southern Denmark, Odense, Denmark.
2
Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, UK.
3
Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
4
Research, Development and Innovation, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK; Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
5
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.
6
Primary Care Research Group, University of Exeter Medical School, Exeter, UK. Electronic address: r.taylor@exeter.ac.uk.

Abstract

AIMS:

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.

KEYWORDS:

Cardiac rehabilitation; Exercise training; Heart failure; Meta-analysis; Systematic review

PMID:
27441476
DOI:
10.1016/j.ijcard.2016.06.207
[Indexed for MEDLINE]

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