Hybrid versus traditional cardiac rehabilitation models: A systematic review and meta-analysis

Abstract

Background: The common drawbacks of standard cardiac rehabilitation (CR) models include low participation rate, high cost, and dependence on on-site exercise sessions. Therefore, hybrid CR protocols have been developed. Aim: We aimed to test whether hybrid CR models are superior or equivalent to the traditional CR models in patients after myocardial infarction, heart failure, and cardiac surgery, using a meta-analysis framework. Methods: Data from relevant original studies indexed in the Medline, Scopus, Cochrane Central, and Web of Science databases were extracted and analysed. The standardised mean difference (SMD) was used as a summary effect estimate, along with 95% confidence interval (CI). Results: Based on data from 1195 patients, the summary effect size showed similar improvement in functional capacity in hybrid and standard CR programmes (SMD = -0.04, 95% CI -0.18 to 0.09, p = 0.51). No significant difference was detected between the two models in terms of changes in exercise duration (SMD = -0.14, 95% CI -0.51 to 0.24, p = 0.47), systolic (SMD = -0.01, 95% CI -0.14 to 0.12, p = 0.91), and diastolic (SMD = -0.03, 95% CI -0.16 to 0.11, p = 0.7) blood pressure, or health-related quality of life (SMD = -0.08, 95% CI -0.23 to 0.07, p = 0.27). In terms of blood lipids, no significant difference was noted between hybrid and traditional CR models in all assessed lipid profile parameters, except for triglycerides (favouring the traditional CR model). Conclusions: Hybrid CR protocols showed comparable efficacy to the traditional model. Further well-designed studies are required to validate these findings, especially regarding the long-term outcomes.