Effectiveness, Efficacy, and Safety of Home-Based Cardiac Rehabilitation Following Valve Replacement or Repair: Protocol for a Systematic Review (Preprint)

Background: Cardiac rehabilitation (CR) is recommended following VRP, yet participation remains suboptimal in this population. Home-based CR (HBCR), including both fully digital and hybrid (mix of HBCR and center-based CR [CBCR]) models, may improve access and uptake. Although prior systematic reviews have examined HBCR in general cardiac populations, none have specifically considered HBCR among patients who have undergone valve replacement or repair procedures (VRP) - an expanding but understudied group with distinct rehabilitation needs. Objective: We aim to perform a systematic review that will evaluate the effectiveness, efficacy, and safety of HBCR compared with CBCR, and usual care/no CR in adults following VRP. Methods: This record describes a protocol for a systematic review. All research questions will be addressed through a de novo systematic review, which considers published and unpublished studies and studies in progress. This systematic review protocol considers guidance from the Preferred Reporting Items for Systematic Review and Meta-analyses - Protocols (PRISMA-P) 2015 statement. We will conduct a systematic search in bibliographic databases and ClinicalTrials.gov. Eligible study designs include randomized and non-randomized controlled trials, controlled observational studies, and single-group cohort or intervention studies. Primary outcomes are major adverse cardiac events (MACE), all-cause mortality, and health system resource use. Secondary outcomes are program adherence, quality of life (QoL), and patient satisfaction. Results: The review formally began in May 2025 and will be conducted and reported according to the protocol; any changes to this protocol will be documented, updated in the PROSPERO registration, and reported alongside the review findings. The results of the review are expected to be published in the summer of 2026. Conclusions: The review aims to focus on clinical-, patient-, and system-important outcomes, which, as a secondary objective, will provide input parameters for planned economic modeling. The findings of this systematic review will inform both practice and policy and provide a foundation for health system-level feasibility assessment, economic modeling, and policy planning related to HBCR in this population. Clinical Trial: PROSPERO CRD420251066703; https://www-crd-york-ac-uk.proxy.bib.uottawa.ca/PROSPERO/view/CRD420251066703