Effectiveness of Quality Improvement Interventions in Cardiac Rehabilitation on Processes and Patient Outcomes: A Systematic Review and Meta-analysis

Aims Significant variability in Cardiac rehabilitation (CR) program content and delivery persists. Quality improvement interventions enhance adherence to standards and reduce variability, yet synthesized evidence of their characteristics and effectiveness in CR is lacking. This meta-analysis aimed to evaluate the effects of quality improvement interventions on CR processes and patient outcomes. Methods Scopus, CENTRAL, Medline, Embase, and CINAHL were searched for studies published from January, 2000 to November, 2024. Study selection in Covidence, data extraction and risk of bias assessment were completed. Where possible, meta-analyses were conducted using RevMan v5.3, random-effects model. Outcomes not suitable for meta-analysis were reported narratively. Results Fifteen studies (76,856 participants) were eligible, including one randomized controlled trial, one retrospective observational study, and 13 pre-post studies. Meta-analysis of 11 studies (17,010 participants) showed that quality improvement interventions significantly improved CR referral (odds ratio [OR] 5.25; 95% confidence interval [CI] 3.11, 8.87). From subgroup analyses, patient education had the largest effect (OR 8.37; 95% CI 4.32, 16.21), followed by technology (OR 5.56; 95% CI 2.67, 11.58) and process changes (OR 5.31; 95% CI 2.53, 11.12). Narrative synthesis indicated that quality improvement interventions led to significant improvements in time from discharge to scheduled appointment (1/1 studies), attendance (3/4), prescription of guideline-directed medical therapy (1/1), and completion (1/1). Few studies reported patient outcomes. Conclusion Quality improvement interventions improve referral to CR up to eight times. While caution is warranted, quality improvement interventions may also lower waits and increase program utilization. Future studies are needed.