Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-03-31 DOI:10.1016/j.ajpc.2025.100982

Eva Marti , Anggoro Budi Hartopo , Haryani , Margareta Hesti Rahayu , Riris Diana , Ninik Yunitri

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Abstract

Aim

To assess the effectiveness of home-based cardiac rehabilitation (HBCR) in improving health-related quality of life (HRQoL) and other outcomes in patients with acute coronary syndrome (ACS), compared to hospital-based cardiac rehabilitation (CR) and usual care.

Methods

This systematic review followed PRISMA guidelines and included a comprehensive search across MEDLINE, CINAHL, ProQuest, Cochrane Library, Clinical Key, PubMed, Embase, and ClinicalTrials.gov up to June 2023. A total of 19 studies with 2822 participants were included. Eligible RCTs assessed the impact of HBCR on ACS patients, comparing it with hospital-based CR or usual care. The primary outcome was QoL, with secondary outcomes including cardiovascular capacity, cardiovascular disease risk factors, and rehospitalization rates. Statistical analysis was conducted using a random-effects model in R Statistic.

Results

HBCR improves QoL compared to all comparators (hospital-based CR and usual care) (SMD 0.17, 95 % CI 0.00 to 0.33). HBCR was equally effective as hospital-based CR in enhancing QoL, peak VO₂, 6-min walk distance (6 MWD), lipid profiles, and blood pressure. Compared to usual care, HBCR significantly improved QoL (SMD 0.29, 95 % CI 0.11 to 0.46) and HDL-cholesterol level (SMD 0.18, 95 % CI 0.02 to 0.34), while reducing triglyceride level more effectively (SMD −0.34, 95 % CI −0.57 to −0.11). However, no significant differences were observed between HBCR and usual care in terms of peak VO₂, rehospitalization rates, LDL-cholesterol, total cholesterol, or blood pressure.

Conclusions

HBCR significantly improves QoL and is equally effective as hospital-based CR across all measured outcomes. Compared to usual care, HBCR leads to significant improvements in specific aspects of QoL as a primary outcome, as well as in HDL-cholesterol and triglyceride levels. However, its impact on other outcomes, such as peak VO₂, LDL-cholesterol, total cholesterol, and blood pressure, is not consistently significant.

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改善急性冠状动脉综合征的预后：一项以家庭为基础与以医院为基础的心脏康复和常规护理的meta分析

目的评价家庭心脏康复（HBCR）与医院心脏康复（CR）和常规护理相比，在改善急性冠脉综合征（ACS）患者健康相关生活质量（HRQoL）和其他结局方面的有效性。方法本系统综述遵循PRISMA指南，纳入了截至2023年6月的MEDLINE、CINAHL、ProQuest、Cochrane Library、Clinical Key、PubMed、Embase和ClinicalTrials.gov的综合检索。共纳入19项研究，共2822名参与者。符合条件的随机对照试验评估了HBCR对ACS患者的影响，并将其与基于医院的CR或常规护理进行比较。主要结局是生活质量，次要结局包括心血管容量、心血管疾病危险因素和再住院率。采用R Statistic中的随机效应模型进行统计分析。结果与所有比较指标（医院CR和常规护理）相比，shbcr改善了生活质量（SMD = 0.17, 95% CI = 0.00 ~ 0.33）。HBCR与基于医院的CR在改善生活质量、峰值VO2、6分钟步行距离（6 MWD）、脂质谱和血压方面同样有效。与常规护理相比，HBCR显著改善了生活质量（SMD 0.29, 95% CI 0.11至0.46）和高密度脂蛋白胆固醇水平（SMD 0.18, 95% CI 0.02至0.34），同时更有效地降低了甘油三酯水平（SMD - 0.34, 95% CI - 0.57至- 0.11）。然而，在峰值VO2、再住院率、低密度脂蛋白胆固醇、总胆固醇或血压方面，HBCR和常规护理之间没有观察到显著差异。结论shbcr显著提高了生活质量，在所有测量结果中与基于医院的CR同样有效。与常规治疗相比，HBCR在生活质量的特定方面（作为主要结局）以及hdl -胆固醇和甘油三酯水平上显著改善。然而，它对其他结果的影响，如峰值VO2、低密度脂蛋白胆固醇、总胆固醇和血压，并不总是显著的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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