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Abstract

Cardiac rehabilitation (CR) aims at decreasing risk and increasing the self-management of care. There is a need to determine which CR interventions are more effective.
Objective: What is the effectiveness of expanded CR compared to standard CR in coronary heart disease (CHD) patients? The review included randomized controlled trials (RCTs) that examine expanded CR compared to standard CR.
Expanded CR was defined as any multimodal intervention added to and targeting secondary prevention by other means than standard CR. Thus, expanded CR was typically reinforced, multifactorial educational and behavioral interventions.
Standard CR consisted of different guideline-defined interventions. There were no requirements for duration and intensity of the interventions. All settings on a global level were considered for inclusion.
The primary outcomes were readmission and mortality. Secondary outcomes were adherence to lifestyle risk factors: cholesterol, Body Mass Index, hypertension, smoking, diet, and physical activity. Databases searched included PubMed, Scopus, CINAHL, clinical.trials.gov and WHO trial registry. The search included English, Danish, Norwegian and Swedish language studies from 2000.
Two reviewers independently assessed the methodological quality of studies and extracted data. Appropriate data could not be pooled for meta-analysis due to heterogeneity of interventions.
The review included 30 RCTs. Compared to standard care one of six expanded CR interventions reduced mortality, and readmission was significantly reduced in seven of 11 RCTs. The most commonly reported outcome was level of cholesterol. In nine of 17 expanded CR interventions level of cholesterol was significantly reduced compared to standard CR. Few RCTs reported on adherence as maintenance of health behaviour. The review indicated beneficial effects of expanded CR compared to standard CR primarily on lifestyle risk factors, suggesting use in CHD patients. However, expanded CR should be tailored to sustainable lifestyle behavior changes measured by adherence to healthy lifestyle and include outcomes of functioning.

Keywords: Coronary heart disease; Cardiac rehabilitation; Prevention program; Patient education; Guideline adherence