5 research outputs found
The promise and challenge of telerehabilitation on cardiac rehabilitation
No abstract available
Circulation and breathing network home-based versus centre-based cardiac rehabilitation
BackgroundCardiovascular disease is the most common cause of death globally. Traditionally, centreābased cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Homeābased and technologyāsupported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARSāCoVā2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017.ObjectivesTo compare the effect of homeābased (which may include digital/telehealth interventions) and supervised centreābased cardiac rehabilitation on mortality and morbidity, exerciseācapacity, healthārelated quality of life, and modifiable cardiac risk factors in patients with heart diseaseSearch methodsWe updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied.Selection criteriaWe included randomised controlled trials that compared centreābased cardiac rehabilitation (e.g. hospital, sports/community centre) with homeābased programmes (Ā± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation.Data collection and analysisTwo review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE.Main resultsWe included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations ā these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.No evidence of a difference was seen between homeā and centreābased cardiac rehabilitation in our primary outcomes up to 12 months of followāup: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; lowācertainty evidence) or exercise capacity (standardised mean difference (SMD) = ā0.10, 95% CI ā0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; lowācertainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in healthārelated quality of life up to 24 months followāup between homeā and centreābased cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI ā0.01 to 0.23; participants = 1074; studies = 3; moderateācertainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; lowācertainty evidence) between homeābased and centreābased participants. The cost per patient of centreā and homeābased programmes was similar.Authors' conclusionsThis update supports previous conclusions that homeā (Ā± digital/telehealth platforms) and centreābased forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and healthārelated quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised homeābased cardiac rehabilitation programmes (Ā± digital/telehealth platforms), especially important in the context of the ongoing global SARSāCoVā2 pandemic that has much limited patients in faceātoāface access of hospital and community health services.Where settings are able to provide both supervised centreā and homeābased programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centreābased and homeābased cardiac rehabilitation delivery.Further data are needed to determine: (1) whether the shortāterm effects of home/digitalātelehealth and centreābased cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of homeābased programmes for other heart patients, e.g. postāvalve surgery and atrial fibrillation