Effectiveness of telehealth-based cardiac rehabilitation in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Abstract

Telehealth-based cardiac rehabilitation programs have emerged as a promising alternative to traditional center-based rehabilitation, offering improved accessibility and convenience for patients undergoing percutaneous coronary intervention (PCI). This review aimed to evaluate the effectiveness of telehealth-based cardiac rehabilitation in improving clinical outcomes in this population. A comprehensive literature search was conducted in MEDLINE, EMBASE, China National Knowledge Infrastructure, and the Cochrane Library from July 2012 to June 2024. Randomized controlled trials and non-randomized studies evaluating telehealth-based cardiac rehabilitation after PCI were included. Outcomes assessed included exercise capacity, blood pressure, body mass index (BMI), quality of life, smoking cessation, major adverse cardiovascular events (MACE), myocardial infarction, and mortality. A random-effects meta-analysis was performed using standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Thirteen studies were included. Telehealth-based interventions significantly improved exercise capacity (SMD = 0.703, 95% CI: 0.382–1.023; p < 0.001) and quality of life (SMD = 0.529, 95% CI: 0.232–0.826; p < 0.001). No statistically significant effects were observed for blood pressure, BMI, smoking cessation, myocardial infarction, or mortality. A potentially clinically important but statistically non-significant trend toward reduced MACE was observed (RR = 0.487, 95% CI: 0.233–1.019; p = 0.056). Although the point estimate corresponds to an approximately 51% relative risk reduction, this finding should be interpreted cautiously because only four studies contributed to the analysis, the confidence interval crossed the null value, and MACE definitions varied across studies. Telehealth-based cardiac rehabilitation improves exercise capacity and quality of life in patients undergoing PCI. A potentially clinically important trend toward reduced MACE was also observed, although this finding remains uncertain because of the limited number of contributing studies, wide confidence interval, and variability in MACE definitions. Evidence for other cardiovascular risk factors and clinical endpoints remains limited. Further adequately powered randomized controlled trials with standardized interventions, outcome definitions, and longer follow-up are required. PROSPERO ID: CRD420261287216