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Research Article| Volume 221, P963-969, October 15, 2016

Home-based cardiac rehabilitation for people with heart failure: A systematic review and meta-analysis

  • Ann-Dorthe Zwisler
    Affiliations
    Danish Centre of Rehabilitation and Palliative Care, University Hospital Odense, Odense, Denmark

    University of Southern Denmark, Odense, Denmark
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  • Rebecca J. Norton
    Affiliations
    Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, UK
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  • Sarah G. Dean
    Affiliations
    Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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  • Hayes Dalal
    Affiliations
    Research, Development and Innovation, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK

    Primary Care Research Group, University of Exeter Medical School, Exeter, UK
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  • Lars H. Tang
    Affiliations
    Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
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  • Jenny Wingham
    Affiliations
    Research, Development and Innovation, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK

    Primary Care Research Group, University of Exeter Medical School, Exeter, UK
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  • Rod S. Taylor
    Correspondence
    Corresponding author at: Institute of Health Research, University of Exeter Medical School, South Cloisters, St Lukes Campus, Heavitree Road, Exeter EX1 2LU, UK.
    Affiliations
    Primary Care Research Group, University of Exeter Medical School, Exeter, UK
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      Abstract

      Aims

      To assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs.

      Methods

      Randomised controlled trials were initially identified from previous systematic reviews of CR. We undertook updated literature searches of MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Library to December 2015. A total of 19 trials with median follow up of 3 months were included — 17 comparisons of home-based CR to usual care (995 patients) and four comparing home and centre-based CR (295 patients).

      Results

      Compared to usual care, home-based CR improved VO2max (mean difference: 1.6 ml/kg/min, 0.8 to 2.4) and total Minnesota Living with Quality of Life score (−3.3, −7.5 to 1.0), with no difference in mortality, hospitalisation or study drop out. Outcomes and costs were similar between home-based and centre-based CR with the exception of higher levels of trial completion in the home-based group (relative risk: 1.2, 1.0 to 1.3).

      Conclusions

      Home-based CR results in short-term improvements in exercise capacity and health-related quality of life of heart failure patients compared to usual care. The magnitude of outcome improvement is similar to centre-based CR. Home-based CR appears to be safe with no evidence of increased risk of hospitalisation or death. These findings support the provision of home-based CR for heart failure as an evidence-based alternative to the traditional centre-based model of provision.

      Keywords

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