Home‐based versus centre‐based cardiac rehabilitation

Background Cardiovascular disease is the most common cause of death globally. Traditionally, centre‐based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home‐based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. Objectives To compare the effect of home‐based and supervised centre‐based cardiac rehabilitation on mortality and morbidity, exercise‐capacity, health‐related quality of life, and modifiable cardiac risk factors in patients with heart disease. Search methods We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. Selection criteria We included randomised controlled trials, including parallel group, cross‐over or quasi‐randomised designs) that compared centre‐based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home‐based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. Data collection and analysis Two review authors independently screened all identified references for inclusion based on pre‐defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. Main results We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home‐ and centre‐based cardiac rehabilitation in clinical primary outcomes up t