Home vs Centre‐Based Cardiac Rehabilitation in Heart Failure Patients: A Systematic Review and Meta‐Analysis

Abstract

Background:Heart failure (HF) is a chronic disease that is characterized by a low functional capacity, low quality of life, and high hospitalization. Cardiac rehabilitation (CR) is a vital part of the HF management that has historically been provided in a center-based program. Nonetheless, there has been the interest in home-based CR models because of enhanced accessibility, decreased expenditure, and escalating telehealth adoption.

Objective: To comparatively evaluate the efficacy of home-based versus centre-based cardiac rehabilitation in heart failure patients with the aim of examining the variables of: exercise capacity, quality of life, hospitalization rates, adherence, and safety.

Methods: The searching period included randomized controlled trials related to the Cochrane Library, Scopus, Embase, and PubMed databases asked to run the systematic search till January 2025. Research that compared the effect of home-based and center-based CR before the adult HF was included. The major results were peak VO 2 and 6-minute walk distance (6MWD). Quality of life scores, hospitalization due to HF, mortality, adherence, and adverse events were secondary outcomes. Random-effects meta-analysis was conducted to calculate the pooled difference in the mean and the risk ratio.

Results: They were 14 qualitative trials with a total of 2,480 HFs. There were similar results with the peak VO 2 between home-based CR and center-based CR (MD: +0.12 mL/kg/min, p=0.41) as well as with 6MWD (MD: +8.4 m, p=0.09). There was a similarity in quality-of-life improvement as measured by MLHFQ or KCCQ. There was no statistically significant difference in HF related hospitalization (RR: 0.96), mortality (RR: 1.02), or adverse events. It is noteworthy that the rate of compliance was higher with home-based CR programs, especially those that added to them telemonitoring or structured remote supervision.

Conclusion: Small-scale cardiac rehab is as beneficial and secure as big-scale initiatives in heart-failure patients, and gains the same advantages in the level of performance and standard of existence. The greater compliance of home-based interventions shows the possibility of a remote and hybrid CR model to provide more access and streamline long-term care of HF.