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.
N1 - Funding Information:
The study was funded by the Public Health Agency of Canada, Ottawa, Ontario. A.M.C. and F.A. Mc. A are supported by career awards from the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta. A.M.C. and M.H. are supported by career awards from the Canadian Institutes of Health Research, Ottawa, Ontario. F.A. McA is joint holder of the Merck-Frosst/Aventis Chair in Patient Health Management.
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
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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 -