Home-based versus centre-based cardiac rehabilitation

McDonagh, Sinead TJ; Dalal, Hasnain; Moore, Sarah; Clark, Christopher E; Dean, Sarah G; Jolly, Kate; Cowie, Aynsley; Afzal, Jannat; Taylor, Rod S

doi:10.1002/14651858.cd007130.pub5

Cited by 12 publications

(12 citation statements)

References 325 publications

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“…The results of the AMSTAR 2 assessment indicated a high methodological quality of all the CSRs (see Table S1). Nine reviews reported the certainty of evidence using the GRADE approach [20][21][22][23][24][25][26][27][28], while the other four did not report GRADE judgement [29][30][31][32]. The included CSRs investigated interventions for the treatment of the rehabilitation needs in patients with IHD on 28 outcomes analysed within 13 comparisons in inpatient and outpatient settings.…”

Section: Resultsmentioning

confidence: 99%

Overview of Cochrane Systematic Reviews on Interventions for Rehabilitation in People with Ischemic Heart Disease: A Mapping Synthesis

Del Furia,

Arienti,

Cattadori

et al. 2024

JCM

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Objectives: This overview of Cochrane Systematic Reviews (CSRs) reports on current evidence and its certainty of the effectiveness of interventions for the rehabilitation of people with ischemic heart disease (IHD), included in the World Health Organization Rehabilitation Programme Package of Interventions for Rehabilitation. Methods: We included all the CSRs relevant to people with IHD. We used a mapping synthesis to group outcomes and comparisons of included CSRs, indicating the effectiveness of interventions for rehabilitation and the certainty of evidence. Results: The evidence map included a total of 13 CSRs. The effect of the interventions varied across comparisons, and the certainty of evidence was inconsistent, ranging from high to very low. We found the best evidence for exercise-based cardiac rehabilitation in the reduction of fatal and non-fatal myocardial infarction and all-cause hospital admission up to 12 months follow-up. Also, combined interventions (work-directed interventions, physical conditioning interventions, and psychological interventions) reduce the days needed for returning to work. Conclusions: The current effect and certainty of evidence for several comparisons investigated support the role of exercise-based cardiac rehabilitation in the management of people with IHD, specifically reducing the risk of fatal and non-fatal myocardial infarction and hospitalisation. However, our findings highlight the lack of high-certainty evidence about hard endpoints, particularly total mortality. Future research should prioritise these primary endpoints to enhance the credibility of cardiac rehabilitation.

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Section: Resultsmentioning

confidence: 99%

Overview of Cochrane Systematic Reviews on Interventions for Rehabilitation in People with Ischemic Heart Disease: A Mapping Synthesis

Del Furia,

Arienti,

Cattadori

et al. 2024

JCM

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“…Notably, of the 23 RCTs, 12 (52%) addressed adverse safety events, and all 12 reported no intervention-related adverse events or deaths, suggesting a certain level of safety in mHealth interventions. In addition, a systematic review assessed the safety of home-based CR (HBCR) programs (digital or telehealth interventions) and concluded that the risk of adverse events occurring is low, thus reassuring the safety of such interventions [ 80 ]. Another review examined the incidence and severity of adverse events associated with HBCR and revealed a low rate of major exercise-related adverse events [ 81 ].…”

Section: Discussionmentioning

confidence: 99%

The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials

Hou,

Liu,

2024

J Med Internet Res

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Background Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20% to 40% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. Objective In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. Methods We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95% CI. Results The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD −0.46, 95% CI −0.83 to −0.08; Z=2.38; P=.02) and depression (SMD −0.34, 95% CI −0.56 to −0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ≥6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (≥90%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). Conclusions On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. Trial Registration PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf

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“…Coronary heart disease (CHD) is a major cause of death and disability globally. 1–3 Secondary prevention programmes such as cardiac rehabilitation (CR) are a level 1A intervention for CHD management in multiple guidelines internationally. 4 , 5 This multicomponent intervention comprises exercise training and lifestyle change education, including physical activity, nutrition, medication compliance, and stress management.…”

Section: Introductionmentioning

confidence: 99%

Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis

Gallegos-Rejas,

Rawstorn,

Gallagher

et al. 2024

European Heart Journal - Digital Health

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Aims Telehealth-delivered cardiac rehabilitation (CR) programmes can potentially increase participation rates while delivering equivalent outcomes to facility-based programmes. However, key components of these interventions that reduce cardiovascular risk factors are not yet distinguished. This study aims to identify features of telehealth-delivered CR that improve secondary prevention outcomes, exercise capacity, participation, and participant satisfaction; and develop recommendations for future telehealth-delivered CR. Methods The protocol for our review was registered with the Prospective Register of Systematic Reviews (#CRD42021236471). We systematically searched four databases (PubMed, Scopus, EMBASE and Cochrane Database) for randomised controlled trials comparing telehealth-delivered CR programmes to facility-based interventions or usual care. Two independent reviewers screened the abstracts and then full-texts. Using a qualitative review methodology (realist synthesis), included articles were evaluated to determine contextual factors and potential mechanisms that impacted cardiovascular risk factors, exercise capacity, participation in the intervention, and increased satisfaction. Results We included 37 reports describing 26 randomised controlled trials published from 2010 to 2022. Studies were primarily conducted in Europe and Australia/Asia. Identified contextual factors and mechanisms were synthesised into four theories required to enhance participant outcomes and participation. These theories are: 1) Early and regular engagement; 2) Personalised interventions and shared goals; 3) Usable, accessible, and supported interventions; and 4) Exercise that is measured and monitored. Conclusions Providing a personalised approach with frequent opportunities for bi-directional interaction were critical features for success across telehealth-delivered CR trials. Real-world effectiveness studies are now needed to complement our findings.

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Home-based versus centre-based cardiac rehabilitation

Cited by 12 publications

References 325 publications

Overview of Cochrane Systematic Reviews on Interventions for Rehabilitation in People with Ischemic Heart Disease: A Mapping Synthesis

Overview of Cochrane Systematic Reviews on Interventions for Rehabilitation in People with Ischemic Heart Disease: A Mapping Synthesis

The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials

Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis

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