Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care
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 f...
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| Language: | English |
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Elsevier
2025-06-01
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| Series: | American Journal of Preventive Cardiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667725000546 |
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| author | Eva Marti Anggoro Budi Hartopo Haryani Margareta Hesti Rahayu Riris Diana Ninik Yunitri |
| author_facet | Eva Marti Anggoro Budi Hartopo Haryani Margareta Hesti Rahayu Riris Diana Ninik Yunitri |
| author_sort | Eva Marti |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-fe1e1c494c134b27bc27de392ce6d273 |
| institution | OA Journals |
| issn | 2666-6677 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj-art-fe1e1c494c134b27bc27de392ce6d2732025-08-20T02:16:02ZengElsevierAmerican Journal of Preventive Cardiology2666-66772025-06-012210098210.1016/j.ajpc.2025.100982Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual careEva Marti0Anggoro Budi Hartopo1 Haryani2Margareta Hesti Rahayu3Riris Diana4Ninik Yunitri5School of Health Sciences Panti Rapih, Yogyakarta, Indonesia; The Doctoral Program in Medical and Health Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia; Corresponding author at: Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Radiopoetro Building Second Floor, Jalan Farmako Sekip Utara, Yogyakarta 55281, Indonesia.Department of Medical-Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaSchool of Health Sciences Panti Rapih, Yogyakarta, Indonesia; The Doctoral Program in Medical and Health Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaThe Doctoral Program in Medical and Health Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Public Health Faculty, Universitas Airlangga, Surabaya, IndonesiaFaculty of Nursing, Universitas Muhammadiyah Jakarta, Jakarta, IndonesiaAim: 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.http://www.sciencedirect.com/science/article/pii/S2666667725000546Home-based cardiac rehabilitationAcute coronary syndromesQuality of lifeCardiovascular capacityRisk factorsRehospitalization |
| spellingShingle | Eva Marti Anggoro Budi Hartopo Haryani Margareta Hesti Rahayu Riris Diana Ninik Yunitri Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care American Journal of Preventive Cardiology Home-based cardiac rehabilitation Acute coronary syndromes Quality of life Cardiovascular capacity Risk factors Rehospitalization |
| title | Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care |
| title_full | Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care |
| title_fullStr | Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care |
| title_full_unstemmed | Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care |
| title_short | Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care |
| title_sort | improving outcomes in acute coronary syndrome a meta analysis of home based compared to hospital based cardiac rehabilitation and usual care |
| topic | Home-based cardiac rehabilitation Acute coronary syndromes Quality of life Cardiovascular capacity Risk factors Rehospitalization |
| url | http://www.sciencedirect.com/science/article/pii/S2666667725000546 |
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