Exercise-based cardiac rehabilitation significantly reduces heart attack risks and hospital admissions, according to a Cochrane review. Analyzing 107 randomized controlled trials, the study confirms that digital and home-based programs offer benefits comparable to traditional center-based models, providing a vital alternative for patients facing participation barriers.
Coronary heart disease is the single most common cause of death globally. It can lead to chest pain, heart attacks, or stroke. Cardiac rehabilitation programmes are widely recommended following a cardiac event, with exercise recognized as a core component.
University of Glasgow Researchers Analyze 107 Clinical Trials on Cardiac Rehab
The researchers, led by the University of Glasgow, analyzed 107 randomized controlled trials involving 26,886 people with coronary heart disease. Most participants had experienced a heart attack, undergone heart procedures, or experienced some sort of chest pain. Women were underrepresented, making up only 17% of participants despite being included in most studies.
This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7,795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years.
In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall (< 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years).
At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials).
The overall results show that, compared with no programme, exercise-based cardiac rehabilitation reduces heart attacks by 28%, reduces all-cause hospital admissions by 35%, and probably reduces deaths.
Our review shows that exercise-based cardiac rehabilitation can reduce the risk of heart attack and hospital admission while helping people return to health.
Participants also reported better physical functioning, general health, vitality, social functioning, and mental wellbeing. These benefits were seen across several validated quality-of-life measures.
Modern Home-Based and Digital Rehabilitation Programs Expand Access
The evidence also suggests that newer home-based and digitally supported cardiac rehabilitation programmes can be just as effective as traditional centre-based services. Cardiac rehabilitation, or cardiac rehab, is a comprehensive secondary prevention program designed to improve cardiovascular health following a cardiac event or procedure.
An optimal cardiac rehab experience consists of 36 one-hour sessions that include team-based supervised exercise training, education and skills development for heart-healthy living, and counseling on stress and other psychosocial factors (Mayo Clinic Proceedings, 2016). Participation in a cardiac rehab program can reduce the risks of death from any cause and from cardiac causes as well as decrease hospital readmissions. Cardiac rehab participation also improves functional status, quality of life, mood, and medication adherence (Cochrane Database of Systematic Reviews, 2016).
Persistent Participation Barriers and Low National Uptake Rates
Despite these benefits, participation in cardiac rehab remains low, ranging from 19% to 34% in a national analysis (Mayo Clinic Proceedings, 2016), with strong state-by-state geographic variations and differences by cardiac diagnosis. While cardiac rehab services are widely covered by public and private plans, co-pays per session represent a financial obstacle for most participants.
Strong evidence shows that cardiac rehab programs can benefit individuals who have had a heart attack, stable angina, received a stent or angioplasty, heart failure with reduced ejection fraction, or undergone bypass, valve, or heart or heart-lung transplant surgery. Improving awareness of its value, increasing referral of eligible patients, and reducing system and patient barriers to participation are all critical steps in improving the referral process.
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