Long-term quality of life, rehospitalization risks, and economic viability of remote cardiac rehabilitation: an updated systematic review and meta-analysis.
6 affiliations
- 1Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
- 2Department of Rehabilitation Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao, China.
- 3Department of Pediatrics, The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
- 4Taishan Institute for Hydrogen Biomedical Research, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China.
- 5Department of Ultrasonography, The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
- 6Shandong Provincial Key Medical and Health Discipline of Emergency Medicine, The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
Abstract
Background
Although remote cardiac rehabilitation (RCR) is a promising alternative to traditional center-based care, evidence regarding its exact impact on health-related quality of life (HRQoL), cardiovascular safety, and economic viability remains fragmented, necessitating a comprehensive synthesis to guide clinical implementation.Objectives
This systematic review and meta-analysis aim to evaluate the HRQoL, cardiovascular safety, and economic viability of RCR versus standard center-based care in cardiovascular disease, with subgroup analyses based on follow-up duration and high-risk patient cohorts.Methods
Literature searches were conducted across multiple databases, including PubMed, Embase, and the Cochrane Library, supplemented by manual screening of relevant references to identify clinical studies on RCR up to July 2026. Two independent review teams performed data extraction and risk of bias assessment using the RevMan software. Meta-analyses were conducted employing random-effects models to calculate pooled effect sizes with corresponding 95% confidence intervals. Heterogeneity was assessed using the Cochrane Q test and I ² statistic, and potential publication bias was evaluated using funnel plots and Egger's test. To evaluate the robustness of the pooled results and explore potential heterogeneity, subgroup and fixed-effects sensitivity analyses were conducted, supplemented by trial sequential analysis (TSA).Results
A total of 45 randomized controlled trials were included in this meta-analysis. RCR significantly improved HRQoL across multiple scales (MacNew: MD = 0.17; MLHFQ: MD = -5.38; P < 0.05), while maintaining SF-36 and HADS outcomes comparable to standard care. Exploratory analyses indicated statistically significant improvements in mental health at 6 months (MD = 1.73, P = 0.03) and physical functioning at 12 months (MD = 1.48, P = 0.0002). Regarding cardiovascular safety, RCR was not associated with a statistically significant increase in the risk of MACEs, all-cause mortality, or adverse events (P > 0.05) compared to conventional care. RCR significantly reduced the risk of cardiac rehospitalization (RR = 0.70, P = 0.01), with exploratory stratified analyses indicating that this favorable association was evident in the hardware-integrated interventions subgroup (RR = 0.59, P = 0.02) and 6-month observation subgroup (RR = 0.38, P < 0.00001), alongside a non-significant numerical protective trend among high-risk patients (RR: 0.59 vs. 0.74, P = 0.15). The economic viability of RCR remains uncertain, critically depending on initial setup outlays, patient scaling, and subsequent healthcare utilization.Conclusions
RCR may serve as an effective and safe alternative to conventional care that improves physical and psychological well-being, was associated with a lower risk of cardiac rehospitalization, and may provide economic value in certain healthcare systems.Systematic review registration
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261374977, PROSPERO CRD420261374977.
Related
- Nurse-led rehabilitation after total hip or knee arthroplasty: a systematic review and meta-analysis of functional recovery, self-efficacy, and quality of life.
- Remote supervised exercise- and physical activity-based rehabilitation for post-stroke depression, anxiety, and quality of life: a systematic review, evidence map, and exploratory quantitative synthesis
- Quality of Movement Assessment after ACL Reconstruction in Youth: A Clinical Framework to Guide Rehabilitation and Return-to-Sport Decision-Making
- ITACARE-P cardiorehab registry: real-world data on quality and outcomes in heart failure and ischaemic heart disease - a prospective observational study protocol of the Italian early post-acute cardiac rehabilitation network.
- Predicting One-Year Psychiatric Rehospitalization Using Natural Language Processing and Machine Learning Methods Based on Clinical Texts
BibTeX
@article{pei2026longterm,
title = {{Long-term quality of life, rehospitalization risks, and economic viability of remote cardiac rehabilitation: an updated systematic review and meta-analysis.}},
author = {Hui Pei and Hengrui Li and Miaomiao Hu and Boyan Liu and Dali Hu and Yuanmin Li and Qiang Xiao},
journal = {Frontiers in digital health},
year = {2026},
month = oct,
doi = {10.3389/fdgth.2026.1935832},
url = {https://europepmc.org/article/MED/42952576},
note = {CC BY},
}
RIS
TY - JOUR
TI - Long-term quality of life, rehospitalization risks, and economic viability of remote cardiac rehabilitation: an updated systematic review and meta-analysis.
AU - Hui Pei
AU - Hengrui Li
AU - Miaomiao Hu
AU - Boyan Liu
AU - Dali Hu
AU - Yuanmin Li
AU - Qiang Xiao
PY - 2026
DA - 2026/10/14
JO - Frontiers in digital health
DO - 10.3389/fdgth.2026.1935832
UR - https://europepmc.org/article/MED/42952576
AB - Background Although remote cardiac rehabilitation (RCR) is a promising alternative to traditional center-based care, evidence regarding its exact impact on health-related quality of life (HRQoL), cardiovascular safety, and economic viability remains fragmented, necessitating a comprehensive synthesis to guide clinical implementation.Objectives This systematic review and meta-analysis aim to evaluate the HRQoL, cardiovascular safety, and economic viability of RCR versus standard center-based care in cardiovascular disease, with subgroup analyses based on follow-up duration and high-risk patient cohorts.Methods Literature searches were conducted across multiple databases, including PubMed, Embase, and the Cochrane Library, supplemented by manual screening of relevant references to identify clinical studies on RCR up to July 2026. Two independent review teams performed data extraction and risk of bias assessment using the RevMan software. Meta-analyses were conducted employing random-effects models to calculate pooled effect sizes with corresponding 95% confidence intervals. Heterogeneity was assessed using the Cochrane Q test and I ² statistic, and potential publication bias was evaluated using funnel plots and Egger's test. To evaluate the robustness of the pooled results and explore potential heterogeneity, subgroup and fixed-effects sensitivity analyses were conducted, supplemented by trial sequential analysis (TSA).Results A total of 45 randomized controlled trials were included in this meta-analysis. RCR significantly improved HRQoL across multiple scales (MacNew: MD = 0.17; MLHFQ: MD = -5.38; P < 0.05), while maintaining SF-36 and HADS outcomes comparable to standard care. Exploratory analyses indicated statistically significant improvements in mental health at 6 months (MD = 1.73, P = 0.03) and physical functioning at 12 months (MD = 1.48, P = 0.0002). Regarding cardiovascular safety, RCR was not associated with a statistically significant increase in the risk of MACEs, all-cause mortality, or adverse events (P > 0.05) compared to conventional care. RCR significantly reduced the risk of cardiac rehospitalization (RR = 0.70, P = 0.01), with exploratory stratified analyses indicating that this favorable association was evident in the hardware-integrated interventions subgroup (RR = 0.59, P = 0.02) and 6-month observation subgroup (RR = 0.38, P < 0.00001), alongside a non-significant numerical protective trend among high-risk patients (RR: 0.59 vs. 0.74, P = 0.15). The economic viability of RCR remains uncertain, critically depending on initial setup outlays, patient scaling, and subsequent healthcare utilization.Conclusions RCR may serve as an effective and safe alternative to conventional care that improves physical and psychological well-being, was associated with a lower risk of cardiac rehospitalization, and may provide economic value in certain healthcare systems.Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261374977, PROSPERO CRD420261374977.
SN - 2673-253X
ER -