Peninsula Medical School (Primary Care), Truro, Cornwall TR1 3HD.
BMJ. 2010 Jan 19;340:b5631. doi: 10.1136/bmj.b5631.
To compare the effect of home based and supervised centre based cardiac rehabilitation on mortality and morbidity, health related quality of life, and modifiable cardiac risk factors in patients with coronary heart disease.
Systematic review.
Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, Embase, CINAHL, and PsycINFO, without language restriction, searched from 2001 to January 2008.
Reference lists checked and advice sought from authors. Included randomised controlled trials that compared centre based cardiac rehabilitation with home based programmes in adults with acute myocardial infarction, angina, or heart failure or who had undergone coronary revascularisation. Two reviewers independently assessed the eligibility of the identified trials and extracted data independently. Authors were contacted when possible to obtain missing information.
12 studies (1938 participants) were included. Most studies recruited patients with a low risk of further events after myocardial infarction or revascularisation. No difference was seen between home based and centre based cardiac rehabilitation in terms of mortality (relative risk 1.31, 95% confidence interval 0.65 to 2.66), cardiac events, exercise capacity (standardised mean difference -0.11, -0.35 to 0.13), modifiable risk factors (weighted mean difference systolic blood pressure (0.58 mm Hg, -3.29 mm Hg to 4.44 mm Hg), total cholesterol (-0.13 mmol/l, -0.31 mmol/l to 0.05 mmol/l), low density lipoprotein cholesterol (-0.15 mmol/l, -0.31 mmol/l to 0.01 mmol/l), or relative risk for proportion of smokers at follow-up (0.98, 0.73 to 1.31)), or health related quality of life, with the exception of high density lipoprotein cholesterol (-0.06, -0.11 to -0.02) mmol/l). In the home based participants, there was evidence of superior adherence. No consistent difference was seen in the healthcare costs of the two forms of cardiac rehabilitation.
Home and centre based forms of cardiac rehabilitation seem to be equally effective in improving clinical and health related quality of life outcomes in patients with a low risk of further events after myocardial infarction or revascularisation. This finding, together with the absence of evidence of differences in patients' adherence and healthcare costs between the two approaches, supports the further provision of evidence based, home based cardiac rehabilitation programmes such as the "Heart Manual." The choice of participating in a more traditional supervised centre based or evidence based home based programme should reflect the preference of the individual patient.
比较基于家庭和基于监督中心的心脏康复对冠心病患者的死亡率和发病率、健康相关生活质量以及可改变的心脏危险因素的影响。
系统评价。
Cochrane 图书馆中的 Cochrane 对照试验中心注册库（CENTRAL）、Medline、Embase、CINAHL 和 PsycINFO，无语言限制，检索时间为 2001 年至 2008 年 1 月。
检查参考文献并向作者咨询。纳入的随机对照试验比较了急性心肌梗死、心绞痛或心力衰竭患者或接受过冠状动脉血运重建的患者的基于中心的心脏康复与基于家庭的方案。两名审查员独立评估确定试验的合格性并独立提取数据。在可能的情况下，联系作者以获取缺失信息。
纳入了 12 项研究（1938 名参与者）。大多数研究招募了心肌梗死后或血运重建后发生进一步事件风险较低的患者。基于家庭和基于中心的心脏康复在死亡率（相对风险 1.31，95%置信区间 0.65 至 2.66）、心脏事件、运动能力（标准化均数差-0.11，-0.35 至 0.13）、可改变的危险因素（收缩压加权均数差 0.58mmHg，-3.29mmHg 至 4.44mmHg）、总胆固醇（-0.13mmol/L，-0.31mmol/L 至 0.05mmol/L）、低密度脂蛋白胆固醇（-0.15mmol/L，-0.31mmol/L 至 0.01mmol/L）或随访时吸烟者的比例相对风险（0.98，0.73 至 1.31））或健康相关生活质量方面没有差异，除了高密度脂蛋白胆固醇（-0.06，-0.11 至 -0.02）mmol/L）。在家庭参与者中，有证据表明依从性更好。两种心脏康复形式的医疗保健费用之间没有明显差异。
对于心肌梗死后或血运重建后发生进一步事件风险较低的患者，家庭和基于中心的心脏康复形式似乎同样有效，可以改善临床和健康相关的生活质量结果。这一发现，以及在患者依从性和医疗保健成本方面没有发现两种方法之间存在差异的证据，支持进一步提供基于证据的家庭心脏康复计划，如“心脏手册”。选择参与更传统的监督中心基于或基于证据的家庭基于计划应该反映个体患者的偏好。
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