Effectiveness of Tele-rehabilitation Programs in Heart Failure: A Systematic Review and Meta-analysis. (June 2021)

• Record Type: Journal Article
• Authors: Cavalheiro, Ana Helena; Silva Cardoso, José; Rocha, Afonso; Moreira, Emília; Azevedo, Luís Filipe
• Is Part Of: Health services insights. Volume 14(2021)
• Publication Date: 2021-06
• Subjects: Tele-rehabilitation -- heart failure -- functional capacity -- quality of life -- hospitalizations; Medical care -- Periodicals; Public health -- Periodicals; Delivery of Health Care; Quality of Health Care; Medical care; Public health; Periodicals; Fulltext; Internet Resources; Periodicals; Periodicals; 362.105
• DOI: 10.1177/11786329211021668
• Languages: English
• ISSNs: 1178-6329

Abstract

Background: Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR). Methods and Results: We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients' functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I 2 = 93%). It also improved patients' quality of life (Minnesota Living with Heart Failure Questionnaire: MD −6.62; CI 95% [−11.40; −1.84]; I 2 = 99%). No major adverse events were reported during TR exercise. Conclusion: TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.