A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease

Alexander M. Clark, Mark Haykowsky, Jennifer Kryworuchko, Todd MacClure, Jess Scott, Marie DesMeules, Wei Luo, Y. Liang, Finlay A. McAlister

Research output: Contribution to journalArticle

89 Scopus citations

Abstract

BACKGROUND: A variety of different types of secondary prevention programs for coronary heart disease (CHD) exist. Home-based programs have become more common and may be more accessible or preferable to some patients. This review compared the benefits and costs of home-based programs with usual care and cardiac rehabilitation. METHODS: A meta-analysis following a systematic search of 19 databases, existing reviews, and references was designed. Studies evaluated home-based interventions that addressed more than one main CHD risk factor using a randomized trial with a usual care or cardiac rehabilitation comparison group with data extractable for CHD patients only and reported in English as a full article or thesis. RESULTS: Thirty-nine articles reporting 36 trials were reviewed. Compared with usual care, home-based interventions significantly improved quality of life [weighted mean difference: 0.23; 95% confidence interval (95% CI): 0.02-0.45], systolic blood pressure (weighted mean difference: -4.36mmHg; 95% CI: -6.50 to -2.22), smoking cessation (difference in proportion: 14%; 95% CI: 0.02-0.26), total cholesterol (standardized mean difference: -0.33; 95% CI: -0.57 to -0.08), and depression (standardized mean difference: -0.33; 95% CI: -0.59 to -0.07). Effect sizes were small to moderate and trials were of low-to-moderate quality. Comparisons with cardiac rehabilitation could not be made because of the small number of trials and high levels of heterogeneity. CONCLUSION: Home-based secondary prevention programs for CHD are an effective and relatively low-cost complement to hospital-based cardiac rehabilitation and should be considered for stable patients less likely to access or adhere to hospital-based services.

Original languageEnglish (US)
Pages (from-to)261-270
Number of pages10
JournalEuropean Journal of Cardiovascular Prevention and Rehabilitation
Volume17
Issue number3
DOIs
StatePublished - Jun 2010
Externally publishedYes

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Keywords

  • Cardiac rehabilitation
  • Disease management
  • Health behavior
  • Health promotion
  • Health services
  • Secondary prevention

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

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