Abstract
Comprehensive cardiac rehabilitation has positive effects on many cardiac risk factors (physical activity, smoking status, cholesterol, anxiety and depression) and can lead to improvements in mortality, morbidity and quality of life. Most formal cardiac rehabilitation in the UK is offered within a hospital or centre setting, although this may not always be convenient or accessible for many cardiac patients, especially those in remote areas. The proportion of eligible patients who successfully complete a cardiac rehabilitation program remains low. There are many reasons for this but geographical isolation and transport issues are important. This systematic review examines the current evidence for home- versus hospital-based cardiac rehabilitation. Home-based cardiac rehabilitation offers greater accessibility to cardiac rehabilitation and has the potential to increase uptake. While there have been fewer studies of home-based cardiac rehabilitation, the available data suggest that it has comparable results to hospital-based programs. Many of these studies are small and heterogeneous in terms of interventions but home-based cardiac rehabilitation appears both safe and effective. Available evidence suggests that it results in longer lasting maintenance of physical activity levels compared with hospital-based rehabilitation and is equally effective in improving cardiac risk factors. Furthermore, it has the potential to be a more cost-effective intervention for patients who cannot easily access their local centre or hospital. Currently home-based cardiac rehabilitation is not offered routinely to all patients but it appears to have the potential to increase uptake in patients who are unable, or less likely, to attend more traditional hospital-based cardiac rehabilitation programs.
Highlights
The benefits of cardiac rehabilitation (CR) in the treatment and prevention of cardiac disease are well established
131 articles were identified by electronic search and 17 of these met the inclusion criteria and were deemed suitable for review, with a further 5 articles sourced from a manual search of reference lists (Fig1)
There were 8 studies that directly compared home-based with hospital-based cardiac rehabilitation participants, and the remaining studies compared home rehabilitation with a control group, this was often poorly defined (Table 1)
Summary
The benefits of cardiac rehabilitation (CR) in the treatment and prevention of cardiac disease are well established. Recent systematic reviews and meta-analyses show that patients who participate in cardiac rehabilitation have significant reductions in mortality and morbidity including improvements in exercise tolerance, symptoms, blood lipid profiles, blood pressure and psychosocial wellbeing. Rural populations may themselves introduce barriers to the uptake of specialist care. Reluctance to use services, combined with the importance of maintaining independence, a decline in community spirit and the fear of being a burden, all raise potential barriers to the delivery of high quality specialist care. Evidence suggests that rural populations tend to be accepting of the fact that living in rural areas necessitates an ‘element of personal responsibility in accessing services’, and that new technology is generally welcomed to improve and provide health care as close as possible to home
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