Article

Cardiac rehabilitation (CR) is an evidence-based recommendation for
patients with coronary artery disease (CAD). However, CR is dramatically
underutilized. Telehealth interventions have the potential to overcome barriers
and may be an innovative model of delivering CR. This review aimed to determine
the effectiveness of telehealth intervention delivered CR compared with
center-based supervised CR. METHOD: Medline, Embase, the Cochrane Central
Register of Controlled Trials (CENTRAL) in the Cochrane Library and the Chinese
BioMedical Literature Database (CBM), were searched to April 2014, without
language restriction. Existing randomized controlled trials, reviews, relevant
conference lists and gray literature were checked. Randomized controlled trials
that compared telehealth intervention delivered CR with traditional center-based
supervised CR in adults with CAD were included. Two reviewers selected studies
and extracted data independently. Main clinical outcomes including clinical
events, modifiable risk factors or other endpoints were measured. RESULTS:
Fifteen articles reporting nine trials were reviewed, most of which recruited
patients with myocardial infarction or revascularization. No statistically
significant difference was found between telehealth interventions delivered and
center-based supervised CR in exercise capacity (standardized mean difference
(SMD) -0.01; 95% confidence interval (CI) -0.12-0.10), weight (SMD -0.13; 95% CI
-0.30-0.05), systolic and diastolic blood pressure (mean difference (MD) -1.27;
95% CI -3.67-1.13 and MD 1.00; 95% CI -0.42-2.43, respectively), lipid profile,
smoking (risk ratio (RR) 1.03; 95% CI 0.78-1.38), mortality (RR 1.15; 95% CI
0.61-2.19), quality of life and psychosocial state. CONCLUSIONS: Telehealth
intervention delivered cardiac rehabilitation does not have significantly
inferior outcomes compared to center-based supervised program in low to moderate
risk CAD patients. Telehealth intervention offers an alternative deliver model of
CR for individuals less able to access center-based cardiac rehabilitation.
Choices should reflect preferences, anticipation, risk profile, funding, and
accessibility to health service.
CI - (c) The European Society of Cardiology 2014.

Langue : ANGLAIS