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

1. Alexander M. Clark^a
2. Mark Haykowsky^a
3. Jennifer Kryworuchko^b
4. Todd MacClure^a
5. Jess Scott^a
6. Marie DesMeules^c
7. Wei Luo^c
8. Y. Liang^a
9. Finlay A. McAlister^a

1. ^aUniversity of Alberta, Edmonton, Alberta
2. ^bUniversity of Ottawa, Ottawa, Ontario
3. ^cPublic Health Agency Canada, Ottawa, Canada

1. Alexander M. Clark, Level 3 CSB, Faculty of Nursing, University of Alberta, Edmonton, AB, T6G 2G3, Canada Tel: + 1 780 492 8347; fax: +1 780 492 2551; e-mail:alex.clark@ualberta.ca

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. Eur J Cardiovasc Prev Rehabil 17:261-270 © 2010 The European Society of Cardiology