Influence Of Home-Based Cardiac Rehabilitation On Health-Related Quality Of Life In Patients Post-Coronary Artery Bypass Graft: A Systematic Review

Abstract

Quality of Life (HRQoL) in Patients Post-Coronary Artery Bypass Graft (CABG).

Study design: Systematic review (SR) with narrative synthesis.

Background: CABG is a major surgery aimed at managing coronary artery disease symptoms. However, its complications can lead to a deterioration in patients’ Health- Related Quality of Life (HRQoL). Despite clinic-based Cardiac Rehabilitation (CR) being strongly recommended to help improve HRQoL, patient participation in and adherence to CR are poor. To help enhance participation, Home-Based Cardiac Rehabilitation (HBCR) has been proposed as an alternative delivery model. Although numerous SRs have investigated HBCR in various cardiovascular diseases, none have focused on its influence on the HRQoL of patients post-CABG, in spite of the substantial burden experienced by these patients on HRQoL compared to the other populations. This SR aimed to collect, critique and review the relevant literature regarding HBCR’s influence on HRQoL in patients post-CABG and compare it with usual care (UC) and centre- based CR (CBCR).

Methodology: A comprehensive search of Medline, EMBASE, CENTRAL, CINAHL and Web of Science databases was performed between 1 January and 15 January 2023 and revealed eight trials that were assessed for methodological rigour by two independent reviewers.

Results: Four randomised controlled trials and one quasi-experimental study with a total of 530 participants were included. All five trials demonstrated significant improvements with HBCR in the physical domains of HRQoL (p<0.01 to p<0.05), and the two trials that included a social domain found similar significant improvements (p < 0.05). Psychological domain scores were inconsistent; while two trials revealed significant improvements (p=0.001 to p<0.01), three trials did not (p>0.05). Compared with UC, HBCR in the three trials elicited significantly greater improvements in all domains (p=0.001 to p<0.05), though one trial did not find a significant difference in the psychological domain (p>0.05). There were no significant differences between HBCR and CBCR in the three trials that compared the two, with both treatments causing significant improvements in physical and social domains (p=0.001 to p<0.05) while not providing significant improvements in the psychological domain (p>0.05). One trial however reported significant improvements in phycological domains in both (p=0.001).

Conclusion: There is consistent evidence of the positive influence of HBCR on both physical and social domains of HRQoL but conflicting results on its influence on the psychological domain. HBCR appears to be superior to UC in its influence on all domains of HRQoL and could be an alternative to CBCR when targeting the physical and social domains of HRQoL. However, neither HBCR nor CBCR had a clear influence on the psychological domain of HRQoL.