A variety of different types of secondary prevention programs for coronary heart disease (CHD) exist. Home-based programs have become more common and may be more accessible or preferable to some patients. This review compared the benefits and costs of home-based programs with usual care and cardiac rehabilitation.
Methods
A meta-analysis following a systematic search of 19 databases, existing reviews, and references was designed. Studies evaluated home-based interventions that addressed more than one main CHD risk factor using a randomized trial with a usual care or cardiac rehabilitation comparison group with data extractable for CHD patients only and reported in English as a full article or thesis.
Results
Thirty-nine articles reporting 36 trials were reviewed. Compared with usual care, home-based interventions significantly improved quality of life [weighted mean difference: 0.23; 95% confidence interval (95% CI): 0.02-0.45], systolic blood pressure (weighted mean difference: − 4.36mmHg; 95% CI: − 6.50 to − 2.22), smoking cessation (difference in proportion: 14%; 95% CI: 0.02-0.26), total cholesterol (standardized mean difference: − 0.33; 95% CI: − 0.57 to − 0.08), and depression (standardized mean difference: − 0.33; 95% CI: − 0.59 to − 0.07). Effect sizes were small to moderate and trials were of low-to-moderate quality. Comparisons with cardiac rehabilitation could not be made because of the small number of trials and high levels of heterogeneity.
ZutzAAndrewIJoannaBScottAL.Utilization of the internet to deliver cardiac rehabilitation at a distance: a pilot study.Telemed J E Health2007; 13:323–330.
2.
ArthurHMSmithKMKodisJMcKelvieR.A controlled trial of hospital versus home based exercise in cardiac patients.Med Sci Sports Exerc2002; 34:1544–1550.
3.
BeckieT.A supportive-educative telephone program: impact on knowledge and anxiety after coronary artery bypass graft surgery.Heart Lung1989; 18:46–55.
4.
BellJ.A comparison of a multi-disciplinary home based cardiac rehabilitation programme with comprehensive conventional rehabilitation in postmyocardial infarction patients. University of London; 1998.
5.
BrosseauR.Safety and feasibility of a self-monitored, home-based phase II exercise program for high risk patients after cardiac surgery.Can J Cardiol1995; 11:675–685.
6.
BrownCAWolfeLAHainsSPymJParkerJO.Early low intensity home exercise after coronary artery bypass graft surgery.J Cardiopulm Rehabil Prev1994; 14:238–245.
7.
ClarkNMJanzNKDodgeJASchorkMAFingerlinTEWheelerJRC. Changes in functional health status of older women with heart disease: Evaluation of a program based on self-regulation.J Gerontol B Psycho Sci Soc Sci2000; 55B:S117–S126.
8.
DalalHMEvansPHCampbellJLTaylorRSWattAReadKLQ. Home-based versus hospital-based rehabilitation after myocardial infarction: a randomized trial with preference arms Cornwall Heart Attack Rehabilitation Management Study (CHARMS).Int J Cardiol2007; 192:202–211.
9.
DeBuskRFHaskellWLMillerNHMillerNHBerraKBarr TaylorC. Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: a new model for patient care.Am J Cardiol1985; 55:251–257.
10.
FletcherBJDunbarSBFelnerJMJensenBEAlmonLCotsonisG. Exercise testing and training in physically disabled men with clinical evidence of coronary artery disease.Am J Cardiol1994; 73:170–174.
11.
Frasure-SmithNLesperanceFPrinceRVerrierPGarberRAJuneauM. Randomized trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction.Lancet1997; 350:473–479.
12.
GallagherRMcKinleySDracupK.Effects of a telephone counseling intervention on psychosocial adjustment in women following a cardiac event.Heart Lung2003; 32:79–87.
13.
GardingBSKerrJCBayK.Effectiveness of a program of information and support for myocardial infarction patients recovering at home.Heart Lung1988; 17:355–362.
14.
GortnerSRGillissCLShinnJASparacinoPARankinSLeavittM. Improving recovery following cardiac surgery: a randomized clinical trial.J Adv Nurs1988; 13:649–661.
15.
GortnerSRJenkinsLS.Self-efficacy and activity level following cardiac surgery.J Adv Nurs1990; 15:1132–1138.
16.
HanssenTANordrehaugJEEideGEHanestadBR.Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention.Eur J Cardiovasc Prev Rehabil2007; 14:429–437.
17.
HellerRFKnappJCValentiLADobsonAJ.Secondary prevention after acute myocardial infarction.Am J Cardiol1993; 72:759–762.
18.
JollyKTaylorRLipGYHGreenfieldSRafteryJMantJ. The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Homebased compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence.Health Technol Assess (Winchester, England)2007; 11:1–118.
19.
KuglerJDimsdaleJEHartleyLHSherwoodJ.Hospital supervised versus home exercise in cardiac rehabilitation: effects on aerobic fitness, anxiety, and depression.Arch Phys Med Rehabil1990; 71:322–325.
20.
LewinBRobertsonIHCayELIrvingJBCampbellM.Effects of self-help post myocardial infarction rehabilitation on psychological adjustment and use of health services.Lancet1992; 339:1036–1040.
21.
LewinRJPFurzeGRobinsonJGriffithsKWisemanSPyeM. A randomized controlled trial of a self-management plan for patients with newly diagnosed angina.B J Gen Pract2002; 52:194–201.
22.
LindenB.Evaluation of a home-based rehabilitation programme for patients recovering from acute myocardial infarction.Intensive Crit Care Nurs1995; 11:10–19.
23.
MarchionniNFattirolliFFumagalliSOldridgeNDel LungoFMorosiL. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction. Results of a randomized, controlled trial.Circulation2003; 107:2201–2206.
24.
McHughFLindsayGHanlonPHuttonIBrownMRMorrisonC.Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial.Heart2001; 86:317–323.
25.
MillerNHHaskellWLBerraKDeBuskRF.Home versus group exercise training for increasing functional capacity after myocardial infarction.Circulation1984; 70:645–649.
26.
MittagOChinaCHobergEJuersEKolendaKDRichardtG. Outcomes of cardiac rehabilitation with versus without a follow-up intervention rendered by telephone (Luebeck follow-up trial): overall and gender-specific effects.Int J Rehabil Res2006; 29:295–302.
27.
RobertsonKKayhkoKKekkiP.A supportive-education home follow-up programme for post MI patients.J Community Nurs2003; 17:4.
28.
SenuzunFFadilogluCBurkeLEPayzinS.Effects of home-based cardiac exercise program on the exercise tolerance, serum lipid values and self-efficacy of coronary patients.Eur J Cardiol Prev Rehabil2006; 13:640–645.
29.
SinclairAConroySDaviesP.Post-discharge home-based support for older cardiac patients: a randomised controlled trial.Age Ageing2005; 34:338–343.
30.
SmithKMArthurHMMcKelvieRSKodisJ.Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation.Eur J Cardiovasc Prev Rehabil2004; 11:313–319.
31.
SouthardBSouthardDNuckollsCW.Clinical trial of an Internet-based case management system for secondary prevention of heart disease.J Cardiopulm Rehabil Prev2003; 23:341–348.
32.
SparksKEShawDKEddyDHanigoskyPVantreseJ.Alternatives for cardiac rehabilitation patients unable to return to a hospital-based program.Heart Lung1993; 22:298–303.
33.
TaylorCBHouston-MillerNAhnDKHaskellWDeBuskRF.The effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients.J Pshychosom Res2007; 62:411–418.
34.
TaylorCBHouston-MillerNHaskellWDeBuskRF.Smoking cessation after acute myocardial infarction: the effects of exercise training.Addict Behav1988; 13:331.
35.
TaylorCBMillerNHSmithPMDeBuskRF.The effect of a home-based, case managed, multifactorial risk-reduction program on reducing psychological distress in patients with cardiovascular disease.J Cardiopulm Rehabil Prev1997; 17:157–162.
36.
TaylorRSWattADalalHMEvansPHCampbellJLReadKL. Homebased cardiac rehabilitation versus hospital-based rehabilitation: a cost effectiveness analysis.Int J Cardiol2007; 119:196–201.
37.
ValeMJJelinekMVBestJDDartAGriggLEHareDLE.; for the Coach Study Group. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Arch Int Med2003; 163:2775–2783.
38.
WuSLinYWChenCLTsaiSW.Cardiac rehabilitation versus home exercise after coronary artery bypass graft surgery: a comparison of heart rate recovery.Am J Phys Med Rehabil2006; 85:711–717.
39.
YoungW.Evaluation of a community-based inner-city disease management program for postmyocardial infarction patients: a randomized controlled trial.CMAJ2003; 169:905–910.
40.
BaladyGJAdesPAComossPLimacherMPinaILSouthardD. Core components of cardiac rehabilitation/secondary prevention programs.Circulation2000; 102:1069–1073.
41.
ClarkAMHartlingLVandermeerBMcAlisterFA.Secondary prevention program for patients with coronary artery disease: a meta-analysis of randomized control trials.Ann Intern Med2005; 143:659–672.
42.
JacksonLLeclercJErskineYLindenW.Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors.Heart2005; 91:10–14.
43.
CooperAFJacksonGWeinmanJHorneR.Factors associated with cardiac rehabilitation attendance: a systematic review of the literature.Clin Rehabil2002; 16:541–552.
44.
DafoeWArthurHStokesHMorrinLBeatonL.Universal access: but when? Treating the right patient at the right time: access to cardiac rehabilitation.Can J Cardiol2006; 22:905–911.
45.
LeonASFranklinBACostaFBaladyGJBerraKAStewartKJ.Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association Scientific Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in Collaboration With the American Association of Cardiovascular and Pulmonary Rehabilitation.Circulation2005; 111:369–376.
46.
ClarkAMHartlingLVandermeerBLisselSMcAlisterFA.The merits of shorter, generalist secondary prevention programs based in primary care: results from a meta regression.Eur J Cardiovasc Prev Rehabil2007; 14:538–546.
47.
WengerNK.Current status of cardiac rehabilitation.J Am Coll Cardiol2008; 51:1619–1631.
48.
HigginsJThompsonSDeeksJAltmanD.Measuring inconsistency in meta analysis.BMJ2003; 327:557–560.
49.
ShawKGennatHO'RourkePDel MarC.Exercise for overweight and obesity (Review).Cochrane Database Syst Rev2007; 4:(CD003817). doi: 10.1.002/14651858.CD.003817.pub3.
50.
JolliffeJAReesKTaylorRSThompsonDROldridgeNEbrahimS.Exercise based rehabilitation for coronary heart disease (a review). Cochrane Libr2001; Issue 4. Art. No.: CD001800. doi: 10.1002/14651858.CD001800.
51.
AshworthNChadKHarrisonEReederBMarshallS.Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev2005; Issue 1. Art No: CD004017. doi: 10.1002/14651858. CD004017.pub2.
52.
DusseldorpEvan ElderenTMaesSMeulmanJKraajjV.A meta-analysis of psychoeducational programs for coronary heart disease patients.Health Psychol1999; 18:506–519.
53.
ClarkAMHartlingLVandermeerBMcAlisterFA.Randomized trials of secondary prevention programs in coronary artery disease: a systematic review. Baltimore, Maryland: Agency for Health Care Research and Quality, US Department of Health; 2005.
54.
JollyKTaylorRSLipGYHStevensA.Home-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: a systematic review and meta-analysis.Int J Cardiol2006; 111:343–351.
55.
HillsdonMFosterCThorogoodM.Interventions for promoting physical activity. Cochrane Database Syst Rev2005; Issue 2 Art No: CD003180. doi: 10.1002/14651858.CD003180.pub2.
56.
KhotUKhotMBajzerCSappSKOhmanEMBrenerSJ. Prevalence of conventional risk factors in patients with coronary heart disease.JAMA2003; 290:898–904.
57.
YusufSHawkenSOunpuuSDansTAvezumALanasF.Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.Lancet2004; 364:937–952.
58.
WilsonKGibsonNWillanACookD.Effect of smoking cessation on mortality after myocardial infarction.Arch Int Med2000; 160:939–944.
59.
De LorgerilMSalenPMartinJMonjaudIDelayeJMamelleN.Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction: final Report of the Lyon Diet Heart Study.Circulation1999; 99:779–785.
60.
FrazierCShahSArmstrongPWBhapkarMVMcGuireDKSadowskiZ. for the SYMPHONY and the Second SYMPHONY Investigators. Prevalence and management of hypertension in acute coronary syndrome patients varies by sex: observations from the Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute Coronary Syndromes (SYMPHONY) randomized clinical trials.Am Heart J2005; 150:1260–1267.
61.
Van MelleJde JongePSpijkermanTTijssenJGPOrmelJvan VeldhuisenDJ. Prognostic Association of Depression Following Myocardial Infarction with Mortality and Cardiovascular Events: a Meta-analysis.Psychosom Med2004; 66:814–822.
62.
ThompsonSG.Why and how sources of heterogeneity should be investigated. In: EggerMDavey SmithGAltmanDG, editors. Systematic review in health care: meta analysis in context. London: BMJ Books; 2001. pp. 157–175.
63.
SuttonAAbramsKRJonesDRSheldonTASongF.Methods for metaanalysis in medical research. New York: John Wiley; 2000.
64.
KotsevaKWoodDDe BackerGDe BacquerDPyoralaKKeilU. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries.Eur J Cardiovasc Prev Rehabil2009; 6:121–137.
