The Effect of Internet-Based Cardiac Rehabilitation on Anxiety, Depression, and Quality of Life Among Patients With Ischemic Heart Disease

BACKGROUND: Internet-based cardiac rehabilitation (IBCR) is an innovative, alternative platform used in current practice for the secondary prevention of ischemic heart disease (IHD). The impact of IBCR on anxiety, depression, and quality of life (QoL) in patients with IHD remains inconclusive. OBJECTIVE: To explore the effect of IBCR on anxiety, depression, and QoL among patients with IHD. METHODS: Five databases (Embase, CINAHL, Medline, Cochrane, and Web of Science) and additional resources were searched to identify studies published between January 2014 and March 2024. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Critical Appraisal Skills Program checklist were used. Two reviewers independently assessed study quality, eligibility, and data extraction. RevMan (version 5.3) software was used for the meta-analysis. The protocol was registered in PROSPERO (CRD42023387666). RESULTS: Thirteen randomized controlled trials were included across 9 countries. A total of 2256 participants, with a mean age ranging from 55 to 63 years, the majority being men (73%), were identified. IBCR did not significantly reduce anxiety (P = .22) or depression (P = .44) or increase QoL (P = .21) compared with usual care. Intervention was delivered mainly via smartphones. Physical activities and risk factor management were mostly used, and behavioral changes less likely occurred. Hospital Anxiety and Depression Scale was mostly used. CONCLUSIONS: IBCR was comparable to the effects of usual care in cardiac rehabilitation. Theory-driven interventions with larger and diverse sample sizes, and longer durations across different regions, are recommended for reliable findings.