Home based cardiac rehabilitation an option for low risk patients

January 01, 0001

Home based cardiac rehabilitation an option for low risk patients

This group of British investigators set out to compare the effect of home based and supervised center based cardiac rehabilitation in terms of mortality, morbidity, quality of life, and modifiable cardiac risk factors. They conducted a systematic review using the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, and PsycINFO, without language restriction, from 2001 to 2008. Two reviewers independently assessed the trials and extracted data. Original authors were contacted to obtain missing information.

The researchers report: "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 (relative risk 1.31), cardiac events, exercise capacity (standardised mean difference -0.11) modifiable risk factors (weighted mean difference systolic blood pressure 0.58 mm Hg), total cholesterol (-0.13 mmol/l), low density lipoprotein cholesterol (-0.15 mmol/l), or relative risk for proportion of smokers at follow-up (0.98), or health related quality of life, with the exception of high density lipoprotein cholesterol (-0.06 mmol/l). 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."

The authors concluded: "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."

This systematic review find that home based cardiac rehabilitation for low risk patients is both effective and increases adherence, and should be considered as an option vis-à-vis the classic center based cardiac rehabilitation.

For the full abstract, click here.

BMJ 340:b5631, 19 January 2010
© 2010 Dalal et al.
Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. Hasnain M Dalal, Anna Zawada, Kate Jolly, Tiffany Moxham, and Rod S Taylor. Correspondence to H M Dalal: [email protected]

Category: K. Circulatory. Keywords: cardiac rehabilitation, home based, center based, myocardial infarction, revascularization, systematic review with meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 5 March 2010

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