Digital cardiac rehabilitation versus traditional cardiac rehabilitation in improving health parameters, patient satisfaction and adherence to guidelines-a systematic review and a meta-analysis.

Abstract

Background: Cardiovascular diseases (CVD) remain the leading cause of death worldwide. Digital cardiac rehabilitation (DCR) has emerged as a supplementary concept alongside traditional cardiac rehabilitation (TCR) since the coronavirus disease 2019 (COVID-19) pandemic. Several studies have compared the efficacy of DCR with TCR, with mixed results. This study, registered with PROSPERO (CRD420251029747), aimed to compare the efficacy of DCR with TCR and highlight knowledge gaps for future interventions. The objectives of this study were divided into primary and secondary. The primary endpoints were all-cause hospital readmissions, cardiac-related readmissions, major adverse cardiac events (MACE), all-cause mortality, exercise capacity, and adherence. The secondary endpoints were glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c), systolic blood pressure, quality of life, physical inactivity, healthy diet, smoking status, and medication adherence.

Methods: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cochrane, MEDLINE, PubMed, EMBASE, Google Scholar and ClinicalTrials.gov were searched for relevant studies. Randomised studies published in the English language, including randomised controlled trials (RCTs) and observational studies, were included in this review. These studies were selected from peer-reviewed journals between January 2010 and January 2025. Critical assessments were conducted using the Critical Appraisal Skills Programme (CASP) tool and the Risk of Bias 2 (ROB2) tool for RCTs, and the Risk of Bias in Non-Randomised Studies of Interventions (ROBINs-I) tool for observational studies. We extracted relevant demographic data for primary and secondary outcomes, and the analysis was performed using RevMan statistical software. A random- or fixed-effects model was used for the meta-analysis, depending on the level of heterogeneity across studies. Funnel plots were created to assess publication bias.

Results: A total of 36 eligible studies were included in this systematic review and meta-analysis. A total of 7,257 patients from 36 selected RCTs were included in this study, with 3,340 in the DCR group and 3,917 in the TCR group, respectively. Compared to TCR, DCR was associated with significantly lower all-cause hospital readmission 0.37 [95% confidence interval (CI): 0.25-0.56; P<0.001], cardiac-related readmissions [odds ratio (OR): 0.35; 95% CI: 0.23-0.51; P<0.001], 1.4 times higher cardiac rehabilitation adherence, and better exercise capacity [peak oxygen uptake (PVO₂) and 6-minute walk test (6MWT)]. Also, compared to TCR, DCR resulted in lower physical inactivity (OR: 0.32; 95% CI: 0.25-0.41; P<0.001), unhealthy diet (OR: 0.59; 95% CI: 0.39-0.90; P=0.01), and current smoking OR: 0.65; 95% CI: 0.52-0.81; P<0.001). There was no statistical difference between the two groups for other outcomes.

Conclusions: DCR appears to lead to better cardiovascular health outcomes than TCR. However, due to the different study limitations, these results are tentative, and more studies will be needed to confirm the findings.