Effects of Remote, Virtual, or Hybrid Cardiac Rehabilitation Supported by mHealth in Patients With Heart Failure: A Systematic Review and Meta-Analysis (Preprint)

Background: In heart failure patients, cardiac rehabilitation(CR) is recommended. However, center-based cardiac rehabilitation (CBCR) experiences low referral rates, accessibility barriers, and economic constraints, leading to low usage rate. Mobile health offers a potential solution to these limitations through the remote delivery of home-based cardiac rehabilitation (HBCR). Objective: The objective of this systematic review and meta-analysis was to evaluate the comparative effectiveness of mobile health (mHealth) HBCR interventions versus usual care and CBCR among heart failure patients. Methods: Four electronic databases (MEDLINE, PubMed, Cochrane Library, and Embase) were searched from inception to October 27, 2025, without restrictions on language or publication type. Eligible studies comprised randomized controlled trials enrolling heart failure patients aged 18 years and older, with comparisons between mHealth HBCR interventions and usual care or CBCR. The primary outcome of interest was aerobic exercise capacity, as assessed by peak oxygen consumption (VO2 peak) or the 6-minute walk test (6MWT). Secondary outcomes included health-related quality of life. This review was registered in PROSPERO (CRD420251162078). Results: A total of 4,540 records were identified, and 62 underwent full-text assessment. Seven randomized controlled trials that met the inclusion criteria were included in the systematic review, encompassing 1,307 patients with heart failure. Intervention durations ranged from 8 to 12 weeks, and exercise frequencies varied from daily to five times per week. A random-effects meta-analysis demonstrated that mHealth HBCR significantly improved VO2 peak(SMD 0.36, 95% CI 0.11 to 0.62; p = 0.01) and the SF-36 score (SMD 0.16, 95% CI 0.03 to 0.28; p = 0.01). Compared with usual care, mHealth HBCR was associated with significant improvements in the 6MWD(SMD 0.81, 95% CI 0.23 to 1.39; p = 0.01) and MLHFQ score (SMD -0.57, 95% CI -0.98 to -0.17; p < 0.01). No significant differences were observed between mHealth HBCR and CBCR. Conclusions: MHealth HBCR significantly enhances aerobic exercise capacity and quality of life among heart failure patients. However, further large-scale randomized controlled trials are warranted to elucidate the impact of mHealth HBCR on all-cause mortality, major adverse cardiovascular events, and rehospitalization rates among heart failure patients. Clinical Trial: The protocol was registered in PROSPERO with ID CRD420251162078. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251162078