The aim of this network meta-analysis was to evaluate the effectiveness of centre-based, home-based and telephone-based cardiac rehabilitation in people with coronary heart disease. This review included randomized controlled trials of adult patients (18 years and older) with coronary heart disease that compared exercise-based cardiac rehabilitation with other cardiac rehabilitation modalities or usual care. Exercise-based cardiac rehabilitation modalities were classified as centre-based (cardiac rehabilitation undertaken in a hospital or centre with equivalent structure), home-based (cardiac rehabilitation undertaken at patients’ home or facilities other than hospitals, such as community centres) or telephone-based rehabilitation (cardiac rehabilitation undertaken at patients’ home but monitored and guided by health professionals using telehealth technologies. Risk of bias was assessed using the Cochrane risk of bias tool. Primary outcome was all-cause mortality. Pairwise meta-analysis were performed first to estimate the direct effect of the exercise-based interventions. Subsequently, a network meta-analysis was performed. In total, 60 randomised controlled trials were included (n = 19,411). Only half of the studies reported details of the exercise programs (types of exercise, frequency, lengths of sessions and duration of rehabilitation). Findings from the network meta-analysis showed that only centre-based cardiac rehabilitation significantly reduced all-cause mortality compared to usual care (relative risk 0.76, 95% CI 0.64 to 0.90), while the other types of cardiac rehabilitation were not significantly different from usual care with regard to mortality: home-based versus usual care (relative risk 0.86, 95% CI 0.55 to 1.33); telephone-based versus usual care (relative risk 0.97, 95% CI 0.62 to 1.52). This network meta-analysis showed that centre-based cardiac rehabilitation is the most appropriate therapeutic approach for patients with coronary heart disease.
Xia T-L, et al. Efficacy of different types of exercise-based cardiac rehabilitation on coronary heart disease: a network meta-analysis. J Gen Intern Med 2018;33(12):2201-9