Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care: 34 months (end of the program) and 9-10 months (6 months after the end of the program)

Aim: To assess the effectiveness of home-based cardiac rehabilitation (HBCR) in improving health-related quality of life (HRQoL) and other outcomes in patients with acute coronary syndrome (ACS), compared to hospital-based cardiac rehabilitation (CR) and usual care. Methods: This systematic review followed PRISMA guidelines and included a comprehensive search across MEDLINE, CINAHL, ProQuest, Cochrane Library, Clinical Key, PubMed, Embase, and ClinicalTrials.gov up to June 2023. A total of 19 studies with 2822 participants were included. Eligible RCTs assessed the impact of HBCR on ACS patients, comparing it with hospital-based CR or usual care. The primary outcome was QoL, with secondary outcomes including cardiovascular capacity, cardiovascular disease risk factors, and rehospitalization rates. Statistical analysis was conducted using a random-effects model in R Statistic. Results: HBCR improves QoL compared to all comparators (hospital-based CR and usual care) (SMD 0.17, 95 CI 0.00 to 0.33). HBCR was equally effective as hospital-based CR in enhancing QoL, peak VO₂, 6-min walk distance (6 MWD), lipid profiles, and blood pressure. Compared to usual care, HBCR significantly improved QoL (SMD 0.29, 95 CI 0.11 to 0.46) and HDL-cholesterol level (SMD 0.18, 95 CI 0.02 to 0.34), while reducing triglyceride level more effectively (SMD 0.34, 95 CI 0.57 to 0.11). However, no significant differences were observed between HBCR and usual care in terms of peak VO₂, rehospitalization rates, LDL-cholesterol, total cholesterol, or blood pressure. Conclusions: HBCR significantly improves QoL and is equally effective as hospital-based CR across all measured outcomes. Compared to usual care, HBCR leads to significant improvements in specific aspects of QoL as a primary outcome, as well as in HDL-cholesterol and triglyceride levels. However, its impact on other outcomes, such as peak VO₂, LDL-cholesterol, total cholesterol, and blood pressure, is not consistently significant. © 2025