Digital Cardiac Rehabilitation Following Coronary Revascularization: Effectiveness, Safety, Implementation Barriers and Future Development

Background/Objectives: To critically review the effectiveness, safety and implementation of fully remote, hybrid and digitally supported cardiac rehabilitation (CR) in adults after coronary revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), distinguishing direct from indirect evidence. Methods: This structured narrative review drew on searches of MEDLINE (PubMed), Embase, the Cochrane Library, Scopus and Web of Science, supplemented by reference list and citation searching and by guidance from major cardiology societies. Randomized and non-randomized comparative studies, economic evaluations, qualitative studies and systematic reviews were selected purposively, appraised qualitatively for methodological limitations, and synthesized narratively by outcome, comparator, intervention comprehensiveness and directness of evidence for revascularized patients. Results: Compared with usual care, digital CR improved short-term exercise capacity; compared with center-based CR, it produced broadly similar exercise capacity and short- to intermediate-term quality of life. Lower odds of all-cause readmission with digital CR in one meta-analysis (OR 0.37, 95% CI 0.25–0.56) were based on only seven heterogeneous studies (n = 859) and are not corroborated by the 2023 Cochrane review; effects on major adverse cardiovascular events and mortality remain uncertain. Economic evaluations were generally favorable. Serious exercise-related adverse events were rarely reported in the selected, predominantly lower-risk participants studied, but surveillance was inconsistent, and safety after CABG and in higher-risk patients has not been established. Reimbursement, workforce capacity, interoperability and digital exclusion were the main implementation barriers. Conclusions: Comprehensive remote or hybrid CR is a reasonable option for appropriately assessed, clinically stable, lower-risk patients, particularly after PCI, and a promising way to reach those who would otherwise receive no rehabilitation; patients in the early period after CABG or at higher risk should start with supervised center-based or hybrid care. Digital CR should widen access to multidisciplinary rehabilitation rather than replace supervised programs, and adequately powered trials with long-term clinical and standardized safety outcomes are needed.