Background:
Centre-based cardiac rehabilitation (CBCR) is underused due to low referral rates, accessibility barriers,
and socioeconomic constraints. mHealth technologies have the potential to address some of these challenges through
remote delivery of home-based cardiac rehabilitation (HBCR). This study aims to assess the efects of mHealth HBCR
interventions compared with usual care and CBCR in patients with heart disease.
Methods:
We conducted a systematic review and meta-analysis of randomised controlled trials of mHealth HBCR
interventions. Four electronic databases (MEDLINE, CENTRAL, CINAHL, and Embase) were searched from
inception to March 31, 2023, with no restrictions on language or publication type. Eligible studies were randomised
controlled trials of adult patients (age ≥18 years) with heart disease, comparing mHealth interventions with usual care
or CBCR. The primary outcome of interest was aerobic exercise capacity, assessed with VO2 peak or 6-min walk test
(6MWT). Quality of evidence was assessed using the GRADE system. This review was registered with PROSPERO,
CRD42024544087.
Findings:
Our search yielded 9164 references, of which 135 were retained for full-text review. 13 randomised controlled
trials met eligibility criteria and were included in the systematic review, involving 1508 adults with myocardial
infarction, angina pectoris, or heart failure, or who had undergone revascularisation. Intervention duration ranged
from 6 weeks to 24 weeks. Random-efects meta-analysis showed that, compared with usual care, mHealth HBCR
signifcantly improved 6MWT (mean diference 24·74, 95% CI 9·88–39·60; 532 patients) and VO2 peak (1·77,
1·19–2·35; 359 patients). No signifcant diferences were found between mHealth HBCR and CBCR. Quality of
evidence ranged from low to very low across outcomes due to risk of bias and imprecision (small sample size).
Interpretation mHealth HBCR could improve access and health outcomes in patients who are unable to attend CBCR.
Further research is needed to build a robust evidence base on the clinical efectiveness and cost-efectiveness of
mHealth HBCR, particularly in comparison with CBCR, to inform clinical practice and policy.
Funding: None.