Comparative Systematic Review of Home-Based and Center-Based Cardiac Rehabilitation of Delivery Models and Outcomes

Center-based cardiac rehabilitation (CBCR) is a cornerstone of secondary prevention, yet participation remains limited due to access constraints and adherence barriers. Home-based cardiac rehabilitation (HBCR) has evolved from conventional telephone- and logbook-supported programs to technology-assisted telerehabilitation. However, the extent to which specific delivery models translate into clinical and patient-centered benefits remains unclear.

To compare HBCR and CBCR delivery models and outcomes, and to evaluate whether variation in HBCR delivery approaches is associated with differences in functional capacity, adherence, quality of life, and cardiovascular risk factors.

A PRISMA 2020-guided systematic review of randomized controlled trials compared HBCR with Phase II/III CBCR. Risk of bias was assessed using RoB 2. Outcomes were synthesized narratively, and random-effects meta-analyses (inverse-variance) were conducted where data were sufficiently comparable for VO₂peak, 6-minute walk distance (6MWD), and adherence.

Fourteen trials (2002-2023), including 1,085 participants (22-242 per study), were included. HBCR delivery clustered into traditional programs (exercise prescription with telephone/logbook follow-up) and technology-assisted models (web/app platforms, wearable monitoring, and/or video-supported supervision). Overall risk of bias was low in six trials, some concerns in seven, and high in one; concerns were most commonly related to randomization, while outcome measurement was consistently low risk. Meta-analysis favored HBCR for VO₂peak at follow-up (MD 0.68 mL·kg^-1·min^-1, 95% CI 0.06-1.29; I²=4%), whereas 6MWD showed no between-setting difference (MD -6.77 m, 95% CI -55.06 to 41.52; I²=61%). Adherence modestly favored HBCR (MD 3.24 sessions, 95% CI -0.10 to 6.58; I²=70%). HRQoL and cardiovascular risk factors were generally comparable.

HBCR yields outcomes comparable to CBCR, with small advantages in VO₂peak and adherence, supporting the scalability of HBCR, particularly technology-assisted models, to expand rehabilitation access and uptake.