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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Article info
Publication history
Published online: June 28, 2016
Accepted:
June 25,
2016
Received in revised form:
May 23,
2016
Received:
March 5,
2016
Footnotes
☆All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
