April 2, 2025American Journal of Preventive CardiologyOpen Access

Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care

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Why the study?

The effectiveness of home-based cardiac rehabilitation in improving health-related quality of life and other outcomes in patients with ACS, compared with hospital-based rehabilitation and usual care, needed assessment.

Does home-based cardiac rehabilitation improve quality of life and cardiovascular outcomes in patients with acute coronary syndrome compared to hospital-based cardiac rehabilitation or usual care?

Structured PICO

Does home-based cardiac rehabilitation improve quality of life and cardiovascular outcomes in patients with acute coronary syndrome compared to hospital-based cardiac rehabilitation or usual care?

Population

2,822 adult patients (≥18 years) hospitalized for acute coronary syndrome (ACS) pooled from 19 RCTs. Predominantly low to moderate cardiovascular risk.

Intervention

Home-based cardiac rehabilitation (HBCR) during the outpatient period

Comparator

Hospital-based cardiac rehabilitation (CR) or usual care

Outcome

Quality of life (QoL)patient reported

Home-based cardiac rehabilitation is an effective alternative to hospital-based programs for ACS patients, significantly improving quality of life and specific lipid profiles compared to usual care.

Limitations

Significant variation in QoL measurement instruments across included studies
Limited number of studies reporting rehospitalization and mortality data
Populations predominantly low-to-moderate risk, limiting generalizability to high-risk individuals

Implication

Supports HBCR as accessible alternative in ACS; confirms equivalence to hospital-based CR while extending options beyond usual care.

Abstract

Aim To assess the effectiveness of home-based cardiac rehabilitation (HBCR) in improving health-related quality of life (HRQoL) and other outcomes in patients with acute coronary syndrome (ACS), compared to hospital-based cardiac rehabilitation (CR) and usual care. Methods This systematic review followed PRISMA guidelines and included a comprehensive search across MEDLINE, CINAHL, ProQuest, Cochrane Library, Clinical Key, PubMed, Embase, and ClinicalTrials.gov up to June 2023. A total of 19 studies with 2822 participants were included. Eligible RCTs assessed the impact of HBCR on ACS patients, comparing it with hospital-based CR or usual care. The primary outcome was QoL, with secondary outcomes including cardiovascular capacity, cardiovascular disease risk factors, and rehospitalization rates. Statistical analysis was conducted using a random-effects model in R Statistic. Results HBCR improves QoL compared to all comparators (hospital-based CR and usual care) (SMD 0.17, 95 % CI 0.00 to 0.33). HBCR was equally effective as hospital-based CR in enhancing QoL, peak VO 2 , 6-min walk distance (6 MWD), lipid profiles, and blood pressure. Compared to usual care, HBCR significantly improved QoL (SMD 0.29, 95 % CI 0.11 to 0.46) and HDL-cholesterol level (SMD 0.18, 95 % CI 0.02 to 0.34), while reducing triglyceride level more effectively (SMD −0.34, 95 % CI −0.57 to −0.11). However, no significant differences were observed between HBCR and usual care in terms of peak VO 2 , rehospitalization rates, LDL-cholesterol, total cholesterol, or blood pressure. Conclusions HBCR significantly improves QoL and is equally effective as hospital-based CR across all measured outcomes. Compared to usual care, HBCR leads to significant improvements in specific aspects of QoL as a primary outcome, as well as in HDL-cholesterol and triglyceride levels. However, its impact on other outcomes, such as peak VO 2 , LDL-cholesterol, total cholesterol, and blood pressure, is not consistently significant.