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

88 Citations (Scopus)

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

Fingerprint

Secondary Prevention
Meta-Analysis
Coronary Artery Disease
Coronary Disease
Confidence Intervals
Blood Pressure
Smoking Cessation
Home Care Services
Cost-Benefit Analysis
Cholesterol
Quality of Life
Databases
Depression
Costs and Cost Analysis
Cardiac Rehabilitation

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Epidemiology

Cite this

A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease. / Clark, Alexander M.; Haykowsky, Mark; Kryworuchko, Jennifer; MacClure, Todd; Scott, Jess; DesMeules, Marie; Luo, Wei; Liang, Y.; McAlister, Finlay A.

In: European Journal of Cardiovascular Prevention and Rehabilitation, Vol. 17, No. 3, 06.2010, p. 261-270.

Research output: Contribution to journalArticle

Clark, AM, Haykowsky, M, Kryworuchko, J, MacClure, T, Scott, J, DesMeules, M, Luo, W, Liang, Y & McAlister, FA 2010, 'A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease', European Journal of Cardiovascular Prevention and Rehabilitation, vol. 17, no. 3, pp. 261-270. https://doi.org/10.1097/HJR.0b013e32833090ef
Clark, Alexander M. ; Haykowsky, Mark ; Kryworuchko, Jennifer ; MacClure, Todd ; Scott, Jess ; DesMeules, Marie ; Luo, Wei ; Liang, Y. ; McAlister, Finlay A. / A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease. In: European Journal of Cardiovascular Prevention and Rehabilitation. 2010 ; Vol. 17, No. 3. pp. 261-270.
@article{888aa776174a4d70b6140f32724784c2,
title = "A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease",
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.",
keywords = "Cardiac rehabilitation, Disease management, Health behavior, Health promotion, Health services, Secondary prevention",
author = "Clark, {Alexander M.} and Mark Haykowsky and Jennifer Kryworuchko and Todd MacClure and Jess Scott and Marie DesMeules and Wei Luo and Y. Liang and McAlister, {Finlay A.}",
year = "2010",
month = "6",
doi = "10.1097/HJR.0b013e32833090ef",
language = "English (US)",
volume = "17",
pages = "261--270",
journal = "European Journal of Preventive Cardiology",
issn = "2047-4873",
publisher = "SAGE Publications Ltd",
number = "3",

}

TY - JOUR

T1 - A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease

AU - Clark, Alexander M.

AU - Haykowsky, Mark

AU - Kryworuchko, Jennifer

AU - MacClure, Todd

AU - Scott, Jess

AU - DesMeules, Marie

AU - Luo, Wei

AU - Liang, Y.

AU - McAlister, Finlay A.

PY - 2010/6

Y1 - 2010/6

N2 - 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.

AB - 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.

KW - Cardiac rehabilitation

KW - Disease management

KW - Health behavior

KW - Health promotion

KW - Health services

KW - Secondary prevention

UR - http://www.scopus.com/inward/record.url?scp=77954027155&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954027155&partnerID=8YFLogxK

U2 - 10.1097/HJR.0b013e32833090ef

DO - 10.1097/HJR.0b013e32833090ef

M3 - Article

C2 - 20560165

AN - SCOPUS:77954027155

VL - 17

SP - 261

EP - 270

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

IS - 3

ER -