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

The objective of this study was to compare the effect of home based and supervised centre based cardiac rehabilitation on mortality and morbidity, health related quality of life, and modifiable cardiac risk factors in patients with coronary heart disease.  12 studies (1938 participants) were included. Most studies recruited patients with a low risk of further events after myocardial infarction or revascularisation. No difference was seen between home based and centre based cardiac rehabilitation in terms of mortality, cardiac events, exercise capacity, modifiable risk factors, systolic blood pressure , total cholesterol, low density lipoprotein cholesterol, or relative risk for proportion of smokers at follow-up, or health related quality of life, with the exception of high density lipoprotein cholesterol. In the home based participants, there was evidence of superior adherence. No consistent difference was seen in the healthcare costs of the two forms of cardiac rehabilitation.

Home and centre based forms of cardiac rehabilitation seem to be equally effective in improving clinical and health related quality of life outcomes in patients with a low risk of further events after myocardial infarction or revascularisation. This finding, together with the absence of evidence of differences in patients` adherence and healthcare costs between the two approaches, supports the further provision of evidence based, home based cardiac rehabilitation programmes such as the “Heart Manual.“ The choice of participating in a more traditional supervised centre based or evidence based home based programme should reflect the preference of the individual patient.

Dalal HM, Zawada A, Jolly K, et al. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ. 2010 Jan 19; 340:b5631.

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