OBJECTIVE: To systematically review the safety and the long-term mortality and morbidity risk-rates of the remotely-delivered cardiac rehabilitation (RDCR) interventions in coronary heart disease (CHD) patients. METHODS: The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023455471). Five databases (Pubmed, Scopus, Cochrane Central Register of Controlled Trials in the Cochrane Library, Cinahl and Web of Science) were reviewed from January 2012 up to August 2023. Inclusion criteria were: (a) randomized controlled trials, (b) RDCR implementation of at least 12 weeks duration, (c) assessment of safety, rates of serious adverse events (SAEs) and re-hospitalization incidences at endpoints more than 6 months. Three reviewers independently performed data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool. RESULTS: 14 studies were identified involving 2012 participants and a range of RDCR duration between 3 months to 1 year. The incidence rate of exercise-related SAEs was estimated at 1 per 53,770 patient-hours of RDCR exercise. A non-statistically significant reduction in the re-hospitalization rates and the days lost due to hospitalization was noticed in the RDCR groups. There were no exercise-related deaths. The overall study quality was of low risk. CONCLUSIONS: RDCR can act as a safe alternative delivery mode of cardiac rehabilitation (CR). The low long-term rates of reported SAEs and re-hospitalization incidences of the RDCR could enhance the uptake rates of CR interventions. However, further investigation is needed in larger populations and longer assessment points.

Cardiovascular Research Laboratory Biomedical Research Foundation Academy of Athens Athens Greece

Clinical Exercise Physiology and Rehabilitation Laboratory Department of Physiotherapy School of Health Sciences University of Thessaly Lamia Greece

Department of Physiotherapy and Rehabilitation Faculty of Medicine Masaryk University Brno Czech Republic

Department of Rehabilitation University Hospital Brno Brno Czech Republic

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Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation 2022; 145: e153–e639. PubMed

Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol 2020; 76: 2982–3021. PubMed PMC

Vaduganathan M, Mensah George A, Turco Justine V, et al. The global burden of cardiovascular diseases and risk. J Am Coll Cardiol 2022; 80: 2361–2371. PubMed

Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice: developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2021. DOI: 10.1093/eurheartj/ehab484. PubMed DOI

Stefanakis M, Batalik L, Antoniou V, et al. Safety of home-based cardiac rehabilitation: a systematic review. Heart Lung: J Crit Care 2022; 55: 117–126. 2022/05/10. PubMed

Taylor RS, Dalal HM, McDonagh STJ. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nat Rev Cardiol 2022; 19: 180–194. PubMed PMC

Dibben G, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Syst Rev 2021. DOI: 10.1002/14651858.CD001800.pub4. PubMed DOI PMC

Sandercock GR, Cardoso F, Almodhy M, et al. Cardiorespiratory fitness changes in patients receiving comprehensive outpatient cardiac rehabilitation in the UK: a multicentre study. Heart 2013; 99: 785–790. 2012/11/28. PubMed

Kotseva K, Wood D, De Bacquer D, et al. Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey. Eur J Prev Cardiol 2018; 25: 1242–1251. PubMed

Fraser MJ, Leslie SJ, Gorely T, et al. Barriers and facilitators to participating in cardiac rehabilitation and physical activity: a cross-sectional survey. World J Cardiol 2022; 14: 83–95. 2022/03/24. PubMed PMC

Antoniou V, Pasias K, Loukidis N, et al. Translation, cross-cultural adaptation and psychometric validation of the Greek Version of the Cardiac Rehabilitation Barriers Scale (CRBS-GR): what are the barriers in South-East Europe? Int J Environ Res Public Health 2023; 20. DOI: 10.3390/ijerph20054064. PubMed DOI PMC

Winnige P, Filakova K, Hnatiak J, et al. Validity and reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): determination of key barriers in East-Central Europe. Int J Environ Res Public Health 2021; 18. DOI: 10.3390/ijerph182413113. PubMed DOI PMC

Castellanos LR, Viramontes O, Bains NK, et al. Disparities in cardiac rehabilitation among individuals from racial and ethnic groups and rural communities—A systematic review. J Racial Ethn Health Disparities 2019; 6: 1–11. PubMed

Kirwan R, Perez de Heredia F, McCullough D, et al. Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom. BMC Sports Sci Med Rehabil 2022; 14: 67. PubMed PMC

Stefanakis MBL, Papathanasiou J, Dipla L, et al. Exercise-based cardiac rehabilitation programs in the era of COVID-19: a critical review. Rev Cardiovasc Med; Special Issue ‘Cardiac Rehabilitation’ 2021; 22: 270–275. PubMed

Ramachandran HJ, Jiang Y, Tam WWS, et al. Effectiveness of home-based cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis. Eur J Prev Cardiol 2021. DOI: 10.1093/eurjpc/zwab106. PubMed DOI PMC

Anderson L, Sharp GA, Norton RJ, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2017. DOI: 10.1002/14651858.CD007130.pub4. PubMed DOI PMC

Jin K, Khonsari S, Gallagher R, et al. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2019; 18: 260–271. 2019/01/23. PubMed

Hansen D, Abreu A, Ambrosetti M, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2021. DOI: 10.1093/eurjpc/zwab007. PubMed DOI

Antoniou V, Davos CH, Kapreli E, et al. Effectiveness of home-based cardiac rehabilitation, using wearable sensors, as a multicomponent, cutting-edge intervention: a systematic review and meta-analysis. J Clin Med 2022; 11. DOI: 10.3390/jcm11133772. PubMed DOI PMC

Jin Choo Y, Chang MC. Effects of telecardiac rehabilitation on coronary heart disease: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101(28): e29459. PubMed PMC

Batalik L, Pepera G, Su JJ. Cardiac telerehabilitation improves lipid profile in the long term: insights and implications. Int J Cardiol 2022; 367: 117–118. PubMed

Batalik L, Filakova K, Sladeckova M, et al. The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review. Eur J Phys Rehabil Med 2023; 59: 248–258. 2023/01/25. PubMed PMC

Maddison R, Rawstorn JC, Stewart RAH, et al. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart 2019; 105: 22. PubMed PMC

Avila A, Claes J, Goetschalckx K, et al. Home-based rehabilitation with telemonitoring guidance for patients with coronary artery disease (short-term results of the TRiCH study): randomized controlled trial. J Med Internet Res 2018; 20: e225. 2018/06/24. PubMed PMC

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 2021; 10: 89. PubMed PMC

AHRQ Methods for Effective Health Care. Operating registries. In: Gliklich RE, Leavy MB. (eds) Registries for Evaluating Patient Outcomes: A User’s Guide. 14. Rockville, MD: Agency for Healthcare Research and Quality (US), 2014. PubMed

Higgins JPT, Altman DG, Gøtzsche PC, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clin Res ed) 2011; 343: d5928. PubMed PMC

Frederix I, Solmi F, Piepoli MF, et al. Cardiac telerehabilitation: a novel cost-efficient care delivery strategy that can induce long-term health benefits. Eur J Prev Cardiol 2017; 24: 1708–1717. 2017/09/20. PubMed

Claes J, Buys R, Woods C, et al. PATHway I: design and rationale for the investigation of the feasibility, clinical effectiveness and cost-effectiveness of a technology-enabled cardiac rehabilitation platform. BMJ Open 2017; 7: e016781. 2017/07/02. PubMed PMC

Frederix I, Hansen D, Coninx K, et al. Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalization rate, medical costs and quality of life: a cost-effectiveness analysis. Eur J Prev Cardiol 2016; 23: 674–682. Article. PubMed

Snoek JA, Prescott EI, van der Velde AE, et al. Effectiveness of home-based mobile guided cardiac rehabilitation as alternative strategy for nonparticipation in clinic-based cardiac rehabilitation among elderly patients in Europe: a randomized clinical trial. JAMA Cardiol 2021; 6: 463–468. 2020/10/29. PubMed PMC

Snoek JA, Meindersma EP, Prins LF, et al. The sustained effects of extending cardiac rehabilitation with a six-month telemonitoring and telecoaching programme on fitness, quality of life, cardiovascular risk factors and care utilisation in CAD patients: the TeleCaRe study. J Telemed Telecare 2019. Article. DOI: 10.1177/1357633X19885793. PubMed DOI

Kraal JJ, Elske Van Den Akker-Van Marle M, Abu-Hanna A, et al. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: results of the FIT@Home study. Eur J Prev Cardiol 2017; 24: 1260–1273. Article. PubMed PMC

Lear SA, Singer J, Banner-Lukaris D, et al. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet. Circ Cardiovasc Qual Outcomes 2014; 7: 952–959. 2014/10/02. PubMed

Reid RD, Morrin LI, Beaton LJ, et al. Randomized trial of an internet-based computer-tailored expert system for physical activity in patients with heart disease. Eur J Prev Cardiol 2012; 19: 1357–1364. PubMed

Taylor JL, Holland DJ, Keating SE, et al. Short-term and long-term feasibility, safety, and efficacy of high-intensity interval training in cardiac rehabilitation: the FITR heart study randomized clinical trial. JAMA Cardiol 2020; 5: 1382–1389. Article. PubMed PMC

Widmer RJ, Allison TG, Lennon R, et al. Digital health intervention during cardiac rehabilitation: a randomized controlled trial. Am Heart J 2017; 188: 65–72. 2017/06/05. PubMed

Dorje T, Zhao G, Tso K, et al. Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial. Lancet Digit Health 2019; 1: e363–e374. 2020/12/17. PubMed

Maddison R, Pfaeffli L, Whittaker R, et al. A mobile phone intervention increases physical activity in people with cardiovascular disease: results from the HEART randomized controlled trial. Eur J Prev Cardiol 2015; 22: 701–709. Article. PubMed

Sibilitz KL, Berg SK, Rasmussen TB, et al. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart 2016; 102: 1995–2003. 2016/08/06. PubMed

Osteresch R, Fach A, Frielitz FS, et al. Long-term effects of an intensive prevention program after acute myocardial infarction. Am J Cardiol 2021; 154: 7–13. 2021/07/10. PubMed

World Bank WDI. The World by Income and Region, https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html (2020).

Wienbergen H, Fach A, Meyer S, et al. Effects of an intensive long-term prevention programme after myocardial infarction – a randomized trial. Eur J Prev Cardiol 2019; 26: 522–530. 2018/06/19. PubMed

Claes J, Cornelissen V, McDermott C, et al. Feasibility, acceptability, and clinical effectiveness of a technology-enabled cardiac rehabilitation platform (physical activity toward health-I): randomized controlled trial. J Med Internet Res 2020; 22. Article. DOI: 10.2196/14221. PubMed DOI PMC

Batalik L, Filakova K, Batalikova K, et al. Remotely monitored telerehabilitation for cardiac patients: a review of the current situation. World J Clin Cases 2020; 8: 1818–1831. PubMed PMC

Liu H, Xiao X, Lu C-M, et al. A systematic review of the effect of mobile health on cardiac rehabilitation among coronary heart disease patients. Front Nurs 2018; 5: 217–226.

Widmer RJ, Allison TG, Lerman LO, et al. Digital health intervention as an adjunct to cardiac rehabilitation reduces cardiovascular risk factors and rehospitalizations. J Cardiovasc Transl Res 2015; 8: 283–292. PubMed PMC

Zhong W, Liu R, Cheng H, et al. Longer-term effects of cardiac telerehabilitation on patients with coronary artery disease: systematic review and meta-analysis. JMIR Mhealth Uhealth 2023; 11: e46359. 2023/07/28. PubMed PMC

Golbus JR, Lopez-Jimenez F, Barac A, et al. Digital technologies in cardiac rehabilitation: a science advisory from the American heart association. Circulation 2023; 148: 95–107. 2023/06/05. PubMed

Effects of home-based exercise with telehealth guidance in lymphoma cancer survivors entering cardio-oncology rehabilitation: rationale and design of the tele@home study