Comparing the Outcomes of Digital and Traditional Cardiac Rehabilitation Practices: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to evaluate the effects of digital cardiac rehabilitation (DCR) encompassing application-based telehealth compared to traditional cardiac rehabilitation onmajor adverse cardiovascular events (MACE), rehospitalisation, costs, quality of life (QoL), and physical activity levels in patients with coronary artery disease (CAD). From 2014 to May 2024, a systematic search of the MEDLINE, PubMed, Web of Science, and Scopus databases was conducted using relevant keywords to identify randomised controlled trials (RCTs) or randomised cross-over trials. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale and risk of bias tool. The included articles were then subjected to qualitative synthesis and meta-analysis. Thirteen studies involving 1850 participants were included in the study. Meta-analysis revealed statistically significant improvements in QoL (mean deviation (MD) = 0.10, 95% CI: 0.05-0.15, p = 0.0002). DCR compared with centre-based rehabilitation (CBR). These improvements in QoL likely translated to enhanced daily functioning, such as the increased ability to perform activities of daily living. However, no significant differences were found for physical activity levels (MD = 1.69, 95% CI: 1.49-4.87, p = 0.30), rehospitalisation (relative risk (RR) = 0.86, 95% CI: 0.66-1.11, p = 0.25) or MACE (RR = 0.67, 95% CI: 0.42-1.07, p = 0.09). High heterogeneity was observed in QoL, likely due to variations in DCR modalities, study populations, and intervention content. The results of this study, therefore, must be interpreted with caution. DCR may offer significant benefits in terms of improving the QoL in patients with CAD. While promising trends were observed for rehospitalisation and MACE, further research is needed to confirm these findings. Potential reasons for the observed benefits of DCR over centre-based rehabilitation plausibly include improved accessibility, enhanced patient engagement, and greater flexibility. However, it is important to acknowledge the presence of heterogeneity among the included studies and potential gender imbalances within the study populations, which may have influenced the results. Future research should prioritize long-term outcomes, cost-effectiveness, real-world effectiveness in diverse populations, and the development of standardized DCR protocols.