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Review
Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis
  1. S A Buckingham1,
  2. R S Taylor2,
  3. K Jolly3,
  4. A Zawada4,
  5. S G Dean2,
  6. A Cowie5,
  7. R J Norton6 and
  8. H M Dalal1,2
  1. 1Department of Research, Development & Innovation, Royal Cornwall, Hospitals NHS Trust, Truro, UK
  2. 2Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, Devon, UK
  3. 3Institute for Applied Health Research, University of Birmingham, Birmingham, UK
  4. 4Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
  5. 5Cardiac Rehabilitation, University Hospital Ayr, Ayr, UK
  6. 6Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
  1. Correspondence to Professor RS Taylor; r.taylor{at}exeter.ac.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.

  • CORONARY ARTERY DISEASE
  • HEART FAILURE

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