A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease

Eur J Cardiovasc Prev Rehabil. 2010 Jun;17(3):261-70. doi: 10.1097/HJR.0b013e32833090ef.


Background: A variety of different types of secondary prevention programs for coronary heart disease (CHD) exist. Home-based programs have become more common and may be more accessible or preferable to some patients. This review compared the benefits and costs of home-based programs with usual care and cardiac rehabilitation.

Methods: A meta-analysis following a systematic search of 19 databases, existing reviews, and references was designed. Studies evaluated home-based interventions that addressed more than one main CHD risk factor using a randomized trial with a usual care or cardiac rehabilitation comparison group with data extractable for CHD patients only and reported in English as a full article or thesis.

Results: Thirty-nine articles reporting 36 trials were reviewed. Compared with usual care, home-based interventions significantly improved quality of life [weighted mean difference: 0.23; 95% confidence interval (95% CI): 0.02-0.45], systolic blood pressure (weighted mean difference: -4.36 mmHg; 95% CI: -6.50 to -2.22), smoking cessation (difference in proportion: 14%; 95% CI: 0.02-0.26), total cholesterol (standardized mean difference: -0.33; 95% CI: -0.57 to -0.08), and depression (standardized mean difference: -0.33; 95% CI: -0.59 to -0.07). Effect sizes were small to moderate and trials were of low-to-moderate quality. Comparisons with cardiac rehabilitation could not be made because of the small number of trials and high levels of heterogeneity.

Conclusion: Home-based secondary prevention programs for CHD are an effective and relatively low-cost complement to hospital-based cardiac rehabilitation and should be considered for stable patients less likely to access or adhere to hospital-based services.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Aged
  • Blood Pressure
  • Cholesterol / blood
  • Coronary Artery Disease / economics
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / prevention & control
  • Coronary Artery Disease / rehabilitation
  • Coronary Artery Disease / therapy*
  • Cost-Benefit Analysis
  • Depression / etiology
  • Depression / prevention & control
  • Evidence-Based Medicine
  • Exercise Therapy
  • Female
  • Health Behavior
  • Health Care Costs
  • Health Knowledge, Attitudes, Practice
  • Home Care Services* / economics
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Risk Reduction Behavior
  • Secondary Prevention* / economics
  • Smoking Cessation
  • Treatment Outcome


  • Cholesterol