HOME-BASED VERSUS CENTRE-BASED CARDIAC REHABILITATION OR USUAL CARE IN ELDERLY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Zhiquan Wang* and Li Chee Cynthia Chin

ABSTRACT

Objectives: To evaluate the impact of home-based cardiac rehabilitation (CR) compared to centre-based CR or usual care (UC) on exercise capacity, health-related quality of life (HRQoL), cardiovascular events, and mortality in elderly patients. Methods: This study included randomised controlled trials comparing home-based CR against centre-based CR or UC in elderly patients with coronary heart disease or heart failure. PubMed, EMBASE, CENTRAL, WHO ICTRP and ClinicalTrials.gov were searched systematically on 27 August 2021. Cochrane RoB 2 tools was used for risk of bias assessment. For the meta-analysis, data were pooled using a random-effects model. Results: 19 studies were included, comprising 2,287 participants, contributed to 4 comparisons for home-based CR to centre-based CR, and 17 comparisons to UC. Compared to centre-based CR, the outcomes showed similar effects in terms of exercise capacity (SMD -0.02, 95% CI -0.33 to 0.29, P = 0.90) and HRQoL (SMD -0.25, 95% CI -0.67 to 0.17 P = 0.25). Compared to UC, home-based CR significantly improved exercise capacity (SMD 0.32, 95% CI 0.16 to 0.47, P < 0.0001) and HRQoL (SMD -0.26, 95% CI -0.40 to -0.11, P = 0.0005). For the secondary outcomes, home-based CR significantly improved the all-cause hospitalisation (RR 0.67, 95% CI 0.51 to 0.87, P = 0.003). Conclusion: Provision of home-based CR to elderly patients significantly improved exercise capacity and HRQoL compared to UC, and the effects of home-based CR was similar to centre-based CR. However, there is still limited evidence on the long-term impact of home-based CR in the elderly.

Keywords: Exercise training, coronary heart disease, heart failure, cardiovascular diseases, older adults.