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Open Heart. 2016 Sep 14;3(2):e000463. eCollection 2016.

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

Author information

1
Department of Research, Development & Innovation , Royal Cornwall, Hospitals NHS Trust , Truro , UK.
2
Institute of Health Research (Primary Care), University of Exeter Medical School , Exeter, Devon , UK.
3
Institute for Applied Health Research, University of Birmingham , Birmingham , UK.
4
Agency for Health Technology Assessment and Tariff System , Warsaw , Poland.
5
Cardiac Rehabilitation , University Hospital Ayr , Ayr , UK.
6
Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London , London , UK.
7
Department of Research, Development & Innovation, Royal Cornwall, Hospitals NHS Trust, Truro, UK; Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, Devon, UK.

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

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