Remote Cardiac Rehabilitation for Secondary Prevention of Coronary Heart Disease: A Meta-Analysis Comparing Remote Based Programs versus Usual Care and Center Based Programs

• Author / Creator

  McLean, Lianne D

• Background: The effectiveness of cardiac rehabilitation (CR) programs for coronary heart disease (CHD) is well established; it is associated with improved quality of life, risk factor reduction, and over the long term, a reduction in all cause and cardiac mortality. Despite this effectiveness, program uptake is poor, with as few as 20% of eligible patients participating. Remote CR programs have been developed as an alternative to center-based cardiac rehabilitation delivery and/or usual care. An up-to-date meta-analysis is needed to determine the effectiveness of remote CR compared to center based programs and usual care. Purpose: To determine the effectiveness of remote CR programs for CHD compared to usual care or center-based CR programming. Method: Systematic review of existing literature and meta-analysis of extracted data. Data source: MEDLINE (1992-2014), the EBM Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, and Scopus were searched. Google Scholar and National Library of Medicince clinical trial registry (NLMCTR) were also hand searched as were the reference lists of applicable papers. An updated search was completed in November 2015. Study Selection: Randomized control trials published in a peer-reviewed journal after the year 1995 were eligible for inclusion. 21 trials were identified for inclusion representing 5273 patients with CHD. Data extraction: Two reviewers identified trials and extracted data independently; a random effects model was utilized to conduct statistical analysis. Limitations: Interpretations were limited by the variable quality and heterogeneity of included trials. Poor description of the included CR programs also limited interpretation. Conclusions: There is no statistically difference between remote CR and usual care (17 trials, N=4793, P = 0.84, CI= 0.60-1.88) and remote CR and center based programming (3 Trials, N=720, P=0.71, CI: 0.42-3.54). However, remote CR programs are a superior option compared to usual care and a comparable option to center based based delivery in relation to modifiable risk factors. Compared to usual care, remote programs had a statistically significant impact on SBP (Trials= 9, N=2516, P=0.002), DBP (Trials =6, N=1836, p= 0.005, CI -3.26-0.57), BMI (Trials=10, N=2761, P=0.0009, CI: -1.25-0.32), TC (Trials=10, N=2709, p=0.0002, CI: -0.39-0.12), LDL (Trials=7, N=2007, P=0.0001, CI-0.34-0.11), smoking cessation (Trials=9, N=1492, P=0.0005, CI: 0.21,0.76). Remote interventions were equally as effective as center based programming on SBP (Trials=3, N=611, P=0.88, CI= -3.28-2.81), DBP (trials=3, N=603, p=0.17, CI= -0.05-0.27), Total cholesterol (Trials=3, N=575, P=0.65, CI: -0.32-0.20), LDL (trials=2, N=139, P=0.34, CI: -0.09, 0.27), smoking cessation (Trials=2, N=207, P=0.97, CI: 0.21-0.76). The findings of this review indicate that remote CR programs are a more cost effective and scalable method of delivering CR programming to a broader group or participants.

• Subjects / Keywords

  • Cardiac rehabilitation
  • Secondary prevention
  • Coronary heart disease

• Graduation date

  Spring 2017

• Type of Item

  Thesis

• Degree

  Master of Nursing

• DOI

  https://doi.org/10.7939/R39K4654P

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.